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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602274
Report Date: 07/30/2025
Date Signed: 07/30/2025 03:12:41 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
07/24/2025 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20250724160158
FACILITY NAME:SANTA FE HOME CARE IVFACILITY NUMBER:
198602274
ADMINISTRATOR:GRADNEY, ANGELIQUEFACILITY TYPE:
740
ADDRESS:5010 TORRANCE BLVDTELEPHONE:
(310) 316-0001
CITY:TORRANCESTATE: CAZIP CODE:
90503
CAPACITY:6CENSUS: 5DATE:
07/30/2025
UNANNOUNCEDTIME BEGAN:
09:24 AM
MET WITH:ADMINISTRATION ANGELIQUE GRADNEYTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Residents needs are not being met.
INVESTIGATION FINDINGS:
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On 07/30/2025, Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Santa Fe Home Care IV Facility and was greeted by Administrator Angelique Gradney (S1). LPA Calderon spoke to S1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegation.

The investigation consisted of the following: LPA Calderon interviewed Administrator (S1), Staff (S2-S4), resident (R1-R5), witness (W1). LPA Calderon obtained the following records: Physician report (dated 05/25/2025), Needs and Service plan (dated 06/11/2025), Incident reports (dated 06/26/2025 to 07/17/2025), Admission Agreement (dated 06/05/2025) for R1.

The investigation revealed the following:
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
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-20250724160158
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: 07/30/2025
NARRATIVE
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Regarding the Allegation: Residents’ needs are not being met.

This complaint alleged that staff are not taking care of R1 wounds and needs. LPA Calderon toured the facility and did not witness any negative interactions between staff and residents. LPA Calderon noted the facility was clean. R1 took LPA Calderon to bathroom 1 to inspect as R1 believes the shower is for children. LPA Calderon did not notice any issues with the bathroom and the shower worked properly. Records review indicate the following: The Physician report indicates that R1 is aggressive with staff and has cognitive issues. The Needs and Service plan indicates that R1 can communicate R1 needs and is not conserved. The Incident reports indicate that R1 refuses to take a shower, change R1 clothes, or allow staff to take care of R1 leg wounds. The incident reports indicate that R1 refuses to be taken to the hospital or treat R1 left leg. R1 refuses to be seen by a doctor and will not go to the hospital for evaluation. Interviews indicate the following: 4 out of 4 staff deny the allegation. W1 indicates that R1 refuses to shower or change R1 clothes. W1 indicates that R1 refuses to be seen by a doctor or be taken to the hospital. R1 indicates that R1 does not need any help from staff and R1 does not need to be taken to the hospital for any reason. R1 indicates that R1 does not have any wounds and does not need to take a shower. R1 indicates that the facility provides meals and medication. 2 out of 3 residents deny the allegation. 4 out of 5 residents could not answer any questions. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “Residents needs are not being met” is found to be UNSUBSTANTIATED.

No deficiencies cited during today's visit.

An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Angelique Gradney (S1).

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2