198602274-5-28-2025-11-AS-EMAZ-DHPU24-20250616151119

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602274
Report Date: 05/28/2025
Date Signed: 05/28/2025 03:24:52 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/19/2025 and conducted by Evaluator Deborah Lee

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250519111719

FACILITY NAME:	SANTA FE HOME CARE IV		FACILITY NUMBER:	198602274
ADMINISTRATOR:	GRADNEY, ANGELIQUE		FACILITY TYPE:	740
ADDRESS:	5010 TORRANCE BLVD		TELEPHONE:	(310) 316-0001
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90503
CAPACITY:	6	CENSUS: 4	DATE:	05/28/2025
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Nelson Ortega		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not ensure resident's incontinence needs were being met,
Staff did not respond to resident’s calls for assistance.
Staff did not provide adequate food service to resident

INVESTIGATION FINDINGS:

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On May 28, 2025, Licensing Program Analyst (LPA) Deborah Lee conducted a complaint visit regarding the above allegations. LPA Lee met with Nelson Ortega, House Manager, and explained the reason for the visit.Subsequently, the Administrator Virginia Asis arrived to assist with visit.

The investigation consisted of the following:
On May 28, 2025, LPA and House Manager conduct tour of faciltiy, LPA obtained and reviewed the following: staff roster (4/21/25), resident's roster (dated 4/20/25), Appraisal/Need and Services Plan for R1 (dated 5/17/25), Physician's Report for Residential Care for the Elderly (RCFE) for R1(dated 5/16/25), Staff trainings: Appropriate care of Resident personal hygiene (dated 12/2/24 ), Grooming (dated 5/13/25), Cleanliness (5/13/25), Personal Rights of Residents (dated 5/13/25) and Elder Abuse (dated 11/25/24). LPA observed food supply and facility menu.LPA reviewed (R2-R5) files. LPA conducted 2 staff interviews (S1- S2), Administrator (A1), and 3 resident interviews (R2-R4 ).

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025

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-20250519111719

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SANTA FE HOME CARE IV	FACILITY NUMBER: 198602274
	VISIT DATE: 05/28/2025

NARRATIVE

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Investigation revealed the following:

Allegation: Staff did not ensure resident's incontinence needs were being met

The complaint alleges that during the period of 5/17/25 - 5/18/25 the staff “were not changing and cleaning R1.” On 5/28/25 at 11:56 am, LPA interviewed Administrator (A1) who denied allegation stating that staff tends to all residents’ incontinent needs, "they are always changed when they need to be and the staff constantly check to see if the resident needs changing." A1 further stated that “As long as they are wet, the staff will change them at once.” Lastly, A1 informed LPA that the staff checks the residents every hour.

On 5/28/25, between 9:30am and 1:00pm, LPA interviewed 2 staff (S1-S2)regarding the allegation and (2) out of (2) staff denied the allegation stating; residents are changed on a regular basis, and they are check often and changed at least 4 times a day depending on the need. (2) out of (2) staff stated that they have adequate training on how to care for residents who are incontinent. On 5/28/25, between 1:00pm and 2:00pm, LPA interviewed 3 Residents (R2-R4)). R1 and R5 could not be interviewed as R1 no longer resides at the facility and R5 is nonverbal. Of those interviewed, 3 out of 3 residents denied the allegation, stating that staff change them on a regular basis, and they are never left wet for a long period of time. On 5/28/25, LPA reviewed staff training regarding care for incontinent residents, which indicates that they have knowledge of how to care for residents who are incontinent.

Based on the information gathered, there is insufficient evidence to support the stated allegations

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20250519111719

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SANTA FE HOME CARE IV	FACILITY NUMBER: 198602274
	VISIT DATE: 05/28/2025

NARRATIVE

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Allegation: Staff did not respond to resident’s calls for assistance

The complaint alleges that R1 “called for assistance, and no one came.” On 5/28/25 at 11:56 am, LPA interviewed Administrator (A1) who denied allegation stating that "when resident called for assistance, there was a staff right there to assist R1." On 5/28/25, between 9:30am and 1:00pm, LPA interviewed 2 staff (S1-S2) regarding the allegation and (2) out of ( 2) staff denied the allegation stating R1’s needs were tended to when R1 called for assistance. On 5/28/25, between 1:00pm and 2:00pm, LPA interviewed 3 Residents (R2-R4) who denied allegation. (3) out of (3) residents stated that whenever they would call staff, they responded immediately.

Based on the information gathered, there is insufficient evidence to support the stated allegation.

Allegation: Staff did not provide adequate food service to resident

The complaint alleges that “during that time R1 was at the facility, R1 was only fed sandwiches” On 5/28/25, at 11:56 am, LPA interviewed Administrator (A1) who denied allegation stating they provide adequate food that is nutritious to the residents. On 5/28/25, between 9:30am and 1:00pm, LPA interviewed 2 staff (S1-S2) regarding the allegation and (2) out of (2) staff denied the allegation, stating that they serve adequate and nutritious food and that at no time was any resident served only sandwiches for a meal. On 5/28/25, between 1:00pm and 2:00pm, LPA interviewed 3 Residents (R2-R4) who denied allegation. (3) out of (3) residents stated that they are served nutritious food and they are never served "just sandwiches." Additionally, 3 out of 3 residents stated that they get enough to eat at the facility. On 5/28/25, between 11:00 and 12:00pm, LPA observed food service and the facilities food supply. LPA observed an ample supply of food for the residents in care.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20250519111719

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SANTA FE HOME CARE IV	FACILITY NUMBER: 198602274
	VISIT DATE: 05/28/2025

NARRATIVE

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Based on the information gathered, there is insufficient evidence to support the stated allegation.

Although the allegations above 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 allegations are UNSUBSTANTIATED.

There were no deficiencies cited during today's visit.

Exit interview conducted and report provided to Nelson Ortega, House Manager

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025

LIC9099 (FAS) - (06/04)

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