198320027-12-9-2022-11-AS-MVAO-CQCR5D-20230328124259

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320027
Report Date: 12/09/2022
Date Signed: 12/09/2022 12:22:03 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
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/05/2022 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20221205124420

FACILITY NAME:	GOLDEN CARE LIVING IV		FACILITY NUMBER:	198320027
ADMINISTRATOR:	GRADNEY, STEPHEN		FACILITY TYPE:	740
ADDRESS:	27711 HAWTHORNE BLVD		TELEPHONE:	(310) 989-1941
CITY:	RANCHO PALOS VERDES	STATE: CA	ZIP CODE:	90275
CAPACITY:	6	CENSUS: 2	DATE:	12/09/2022
		UNANNOUNCED	TIME BEGAN:	08:44 AM
MET WITH:	Cathy Espino, Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility not providing heaters for the residents.
Facility does not have a working washing machine for residents to use.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegations listed above. Today’s complaint investigation was conducted with Cathy Espino, Administrator

The investigation consisted of following: Interviews and Record reviews. On 12/05/22, LPA interviewed the Administrator Cathy. The LPA also requested copies of the following documents: Face sheet, Pre-Appraisals, Physician's Report, and Admission Agreement, Copy of purchase invoice for new washing machine. LPA attempted to inspect washing machine. The facility does not have a washing machine, only a dryer. LPA observed and took pictures of 4 heaters the facility had for the residents. One in the living room, one in the residents shared room, one in the kitchen, and one in thedining room. On 12/09/22, LPA interviewed R#1 - R#2, and S#2.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022

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-20221205124420

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
MONTEREY PARK, CA 91754

FACILITY NAME: GOLDEN CARE LIVING IV	FACILITY NUMBER: 198320027
	VISIT DATE: 12/09/2022

NARRATIVE

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Based on the LPA's investigation, the investigation revealed the following:
Allegation 1 – Facility not providing heaters for the residents. Interviews with S#1 & S#2, communicated that they had heaters in the facility. They have always had them. The staff turns the heaters for the residents, so they won't be cold. The residents have their heater in the room and it's always on. Interviews with residents, communicated that the facility gave them heaters and they turn them on for them. LPA observed and took pictures of 4 heaters in the facility for the resident's use. The interviews and observations did not concur with the above allegation.

Allegation 2 - Facility does not have a working washing machine for residents to use. Interviews with the s#1-S#2, communicated that the washing machine broke down, but they purchased a new one for the facility and it will be delivered with the next few days. In the meantime, the administrator is hand washing the thin clothes for the residents and drying them at the facility. The big items laundry and bulk clothes are taken to the laundry mat for the residents until the new machine machine arrives. Interview with the r#1 & R#2, communicated that their laundry is being done for them by the facility. They were not aware the washing machine was broken. The facility provided the invoice for new machine washing purchase. The interviews and records review did not concur with the above allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

An exit interview was conducted with Cathy Espino, Administrator, and a hard copy of report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022

LIC9099 (FAS) - (06/04)

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