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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320024
Report Date: 04/18/2025
Date Signed: 04/18/2025 04:07:55 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/16/2025 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 11-AS-20250416103546
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: 5DATE:
04/18/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:CaregiverTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Staff did not prevent a resident from being exposed to sexual activity.
INVESTIGATION FINDINGS:
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On 04/18/2025, the California Department of Social Services (CDSS) Community Care Community Care Licensing (CCL) Licensing Program Analyst (LPA) Socorro Leandro and LPA Jose Anguiano conducted an initial unannounced complaint visit. LPAs met with Caregiver Dominador Bonifacio and were granted entry to the facility.

The investigation consisted of the following:

On 04/18/2025, records were reviewed, interviews of staff, residents, and witnesses were conducted. Interviews conducted consisted of 5 staff interviews [Staff 1 (S1) to Staff 5 (S5) were interviewed], 3 resident interviews [Resident 2 (R2) to Resident 4 (R4) were interviewed], and 1 witness interview [Witness 1 (W1) was interviewed]. Records reviewed consisted of Resident 1’s (R1) unusual incident reports.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2025
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-20250416103546
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: GOLDEN CARE LIVING III
FACILITY NUMBER: 198320024
VISIT DATE: 04/18/2025
NARRATIVE
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The investigation revealed the following:

Allegation: “Staff did not prevent a resident from being exposed to sexual activity”, it is being alleged that R1 engaged in sexual activity in public (within the facility property, not R1’s bedroom) and staff are not preventing residents from seeing the sexual activities that R1 is engaging in. Interviews conducted with R2 to R4 revealed the following: 3 out 3 residents have not witnessed R1 engaging in sexual activities. Interviews conducted with S1 to S5 revealed the following: 2 out of 5 staff have witnessed R1 engaging in sexual activities in public spaces (e.g. living room and driveway); the two staff indicated that they have also informed R1 that they cannot engage in sexual activities in public spaces but due to the aggression of R1 the two staff have stopped engaging with R1. 1 out 5 staff is aware that R1 has engaged in sexual activities in public spaces but has not witnessed R1 engaging in sexual activities. 3 out 5 staff are unaware if residents in care have witnessed R1 engaging in sexual activities in public spaces. 2 out of 5 staff have not seen or heard about complaints regarding R1 engaging in sexual activities in public spaces. Interviews conducted with W1 revealed the following: W1 observed R1 engaging in sexual activities in facility driveway and observed someone come out of the facility home and walk pass R1 and the individual just kept on walking. R1’s records reviewed revealed the following: The department did not find unusual incident reports indicating that R1 has engaged in sexual activities in public spaces. Based on interviews and records this allegation is unsubstantiated because according to interviews and records residents in care have not witnessed R1 engaging in sexual activities. Unsubstantiated: Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted, and a copy of this report was left with the Caregiver.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2