198320024-4-23-2025-11-AS-UCOL-DGQTEU-20250516144028

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320024
Report Date: 04/23/2025
Date Signed: 04/23/2025 11:50:35 AM

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
03/21/2025 and conducted by Evaluator Socorro Leandro

COMPLAINT CONTROL NUMBER: 11-AS-20250321105226

FACILITY NAME:	GOLDEN CARE LIVING III		FACILITY NUMBER:	198320024
ADMINISTRATOR:	GRADNEY, ANGELIQUE		FACILITY TYPE:	740
ADDRESS:	1308 HICKORY AVE		TELEPHONE:	(310) 787-8369
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90503
CAPACITY:	6	CENSUS: 5	DATE:	04/23/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Caregiver - Jeremy Nebres		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

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Illegal eviction

INVESTIGATION FINDINGS:

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NOTE: This report supersedes the previous report and does not change the findings.

On 04/23/2025, the California Department of Social Services (CDSS) Community Care Community Care Licensing (CCL) Licensing Program Analyst (LPA) Socorro Leandro re-delivered findings. LPA met with Caregiver, Jeremy Nebres was granted entry to the facility.

The investigation consisted of the following: On 03/27/2025, a facility tour was conducted which consisted of a health and safety check for residents in care. On 04/18/2025, Records were reviewed which consisted of emails from Administrator, Angelique Gradney (Administrator, Gradney) and Resident 1’s (R1) records. R1 records consisted of 30-day Eviction Notices, Unusual Incident Reports for the year 2025, Physicians Report dated 03/26/2024, Appraisal and Needs Services Plan dated 03/27/2025, Preplacement dated 02/26/2025, Admission Agreement dated 02/20/2025 and other pertinent documents.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20250321105226

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: 04/23/2025

NARRATIVE

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The investigation revealed the following:

Allegation: “Illegal eviction”, it is being alleged that R1 is getting illegally evicted. Records reviewed revealed the following: On 03/18/2025, R1 received a 30-day Eviction Notice. On 3/18/2025 around 2:38 PM, the department received a 30-day Eviction Notice dated 03/18/2025 for R1 via email from Administrator, Gradney. On 03/25/2025, the department had a conversation with Administrator, Gradney informing them of the changes they need to make to the 30-day Eviction Notice for the notice to be in compliance with California Code of Regulations (CCR) Title 22. On 04/08/2025, Administrator, Gradney emailed the department an updated 30-day Eviction Notice. On 04/10/2025, the department informed Administrator, Gradney of the updates the 30-day Eviction Notice requires to be in compliance with CCR Title 22 regulations. On 04/10/2025 around 11:59 PM, Administrator, Gradney emailed the updated 30-day Eviction Notice. On 04/14/2025, the department informed the Administrator, Gradney that the 30-day Eviction Notice appears to be in compliance with CCR Title 22 regulations. Moreover, R1’s unusual incident reports and eviction notices demonstrate a pattern of aggression toward residents, staff, and the general public. Furthermore, the licensee followed CCR Title 22 regulations by sending a written report of eviction notices within five days. Based on conversations the department has had with Administrator, Gradney and records reviewed this allegation is unsubstantiated. 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 Caregiver, Jeremy Nebres.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025

LIC9099 (FAS) - (06/04)

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