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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320024
Report Date: 02/01/2022
Date Signed: 02/01/2022 03:31:03 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/27/2022 and conducted by Evaluator Lourdes Montoya
COMPLAINT CONTROL NUMBER: 11-AS-20220127102225
FACILITY NAME:GOLDEN CARE LIVING IIIFACILITY NUMBER:
198320024
ADMINISTRATOR:GRADNEY, ANGELIQUEFACILITY TYPE:
740
ADDRESS:1308 HICKORY AVETELEPHONE:
(310) 787-8369
CITY:TORRANCESTATE: CAZIP CODE:
90503
CAPACITY:6CENSUS: 4DATE:
02/01/2022
UNANNOUNCEDTIME BEGAN:
10:17 AM
MET WITH:ANGELIQUE GRADNEYTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff are smoking marijuana at the facility
INVESTIGATION FINDINGS:
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On 2/1/2022, Licensing Program Analysts (LPAs) Lourdes Montoya conducted a 10-day complaint visit at this facility regarding the allegation mentioned above. LPA Montoya called and conducted a risk assessment with Administrator Angelique Gradney. LPA met with the Licensee/Administrator Angelique Gradney, who assisted with the visit. The purpose of the visit was explained.

The investigation consisted of the following: LPA inquired questions relevant to the nature of the complaint. LPA Montoya conducted a tour of the facility; interviewed staff, residents, and a witness. LPA requested and obtained copies of the Staff roster (LIC 500), Resident roster (LIC 9020), residents’ physician’s report, facility house rules, staff rules and personnel file of (S2).

Report continued in LIC 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 11-AS-20220127102225
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME: GOLDEN CARE LIVING III
FACILITY NUMBER: 198320024
VISIT DATE: 02/01/2022
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff are smoking marijuana at the facility

It was alleged that staff are smoking marijuana at the facility. The facility has a current census of four (4) residents and four (4) staff. During the visit, the department interviewed the administrator (S1), 3 Staff (S2-S4), one (1) resident (R1), and Resident’s (R2) responsible party (Witness #1).



Based on the department’s interview with S2 who is the alleged perpetrator, he vapes marijuana outside the facility. He claims he vapes after work hours around 10 pm-11 pm at a nearby park or along Hickory drive on the way to the park. S2 stated he has not reported to the licensee or administrator about his medical prescription of the cannabis. S2 showed the department and to the administrator his medical cannabis ID card which expired on 10/30/2018. S2 admitted he last vaped marijuana about two weeks ago at the park. S2 denied smoking marijuana on the facility premises. Interview with the administrator (1), Staff (S3 and S4), Resident (R3) and Witness (W1) revealed no staff smokes marijuana on the premises. Based on the information gathered, there is no sufficient evidence to corroborate the allegation mentioned above.

Based on LPA’s observations, interviews and record reviews, the preponderance of evidence standard has not been met therefore the above allegation, “Staff are smoking marijuana at the facility” is found to be UNSUBSTANTIATED.

Exit interview conducted. A copy of this report was provided to Licensee/Administrator Angelique Gradney.

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2