198602274-8-22-2025-11-AS-UCOL-DN7PKQ-20251107102332

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602274
Report Date: 08/22/2025
Date Signed: 08/22/2025 09:31:31 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, 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
08/14/2025 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20250814144437

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: 5	DATE:	08/22/2025
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	MANAGER RODOLFO LOZADA		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff made inappropriate comments towards resident
Staff are not providing adequate food service to resident
Staff did not safeguard resident's peresonal belongings
Staff did not ensure resident received a copy of admissions agreemen
Staff did not ensure the shower was not slippery
Staff do not allow resident out of his room

INVESTIGATION FINDINGS:

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On 08/22/2025, Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Santa Fe Home Care IV Facility and was greeted by Manager Rodolfo Lozada (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 allegations.

The investigation consisted of the following: LPA Calderon interviewed Manager (S1), Staff (S2-S3), resident (R1-R4). LPA Calderon obtained the following records: The Physician report (dated 05/21/2025), the Needs and Service plan (dated 06/11/2025), Incident reports (dated 07/17/2025 and 08/13/2025), the Admission Agreement (dated 06/05/2025), Providence Hospital record (dated 08/14/2025), MYO Management nurse notes (dated 08/01/2025), Martin Luther King Hospital record (dated 04/18/2025) for R1. LPA Calderon obtained the facility 2-week meal plan and pictures of residents being served and eating meals. LPA Calderon toured the facility with S1.
The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025

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 4

Control Number 11-AS-20250814144437

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: 08/22/2025

NARRATIVE

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Regarding the Allegation: Staff made inappropriate comments towards residents.

This complaint alleged that staff called R1 inappropriate names. LPA Calderon toured the facility and did not witness any negative interactions between staff and residents. 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. Interviews indicate the following: 3 out of 3 staff deny the allegation. R1 could not be interviewed as R1 moved to a new facility. 3 out of 4 residents deny the allegation. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “Staff made inappropriate comments towards residents” is found to be UNSUBSTANTIATED.

Regarding the Allegation: Staff are not providing adequate food service to residents.

This complaint alleged that staff did not feed R1. LPA Calderon toured the facility and did not witness any negative interactions between staff and residents. LPA Calderon inspected the kitchen and noted 2 day and 7-day supply of food for residents to eat. LPA Calderon reviewed the 2-week meal plan for residents and obtained pictures of R1 eating food. LPA Calderon noted staff serving breakfast to residents in care and making lunch. Interviews indicate the following: 3 out of 3 staff deny the allegation. R1 could not be interviewed as R1 moved to a new facility. 3 out of 4 residents deny the allegation. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “staff are not providing adequate food services to residents” is found to be UNSUBSTANTIATED.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 11-AS-20250814144437

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: 08/22/2025

NARRATIVE

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Regarding the Allegation: Staff did not safeguard residents’ personal belongings.

This complaint alleged that staff stole R1 clothes. LPA Calderon toured the facility and did not witness any negative interactions between staff and residents. LPA Calderon inspected residents’ rooms and noted personal space for residents’ belongings. Interviews indicate the following: 3 out of 3 staff deny the allegation. R1 could not be interviewed as R1 moved to a new facility. 3 out of 4 residents deny the allegation. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “Staff did not safeguard residents’ personal belongings” is found to be UNSUBSTANTIATED.

Regarding the Allegation: Staff did not ensure residents received a copy of the admission agreement.

This complaint alleged that staff did not give a copy of the admission agreement to R1. LPA Calderon toured the facility and did not witness any negative interactions between staff and residents. Records review indicate the following: Reviewed the admission agreement. R1 signed the agreement, and a copy was saved in residents facility file. The Physician report indicates that R1 is aggressive with staff and has cognitive issues. Interviews indicate the following: 3 out of 3 staff deny the allegation. R1 could not be interviewed as R1 moved to a new facility. 3 out of 4 residents deny the allegation. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “staff did not ensure resident received a copy of admission agreement” is found to be UNSUBSTANTIATED.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20250814144437

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: 08/22/2025

NARRATIVE

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Regarding the Allegation: Staff did not ensure the shower was not slippery.

This complaint alleged that staff did not ensure that the shower was safe. LPA Calderon toured the facility and did not witness any negative interactions between staff and residents. LPA Calderon inspected the facility 2 bathrooms and noted that there were grab bars and skid pads on the floor. LPA Calderon noted that the two bathrooms were working correctly. Interviews indicate the following: 3 out of 3 staff deny the allegation. R1 could not be interviewed as R1 moved to a new facility. 3 out of 4 residents deny the allegation. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “Staff did not ensure the shower was not slippery” is found to be UNSUBSTANTIATED.

Regarding the Allegation: Staff do not allow resident out of his room.

This complaint alleged that staff did not allow R1 out of R1 room. LPA Calderon toured the facility and did not witness any negative interactions between staff and residents. LPA Calderon noted residents coming and going from the residents’ rooms. Records review indicate the following: Reviewed pictures of R1 out of R1 room eating at the dining room table. The Physician report indicates that R1 is aggressive with staff and has cognitive issues. Interviews indicate the following: 3 out of 3 staff deny the allegation. R1 could not be interviewed as R1 moved to a new facility. 3 out of 4 residents deny the allegation. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “Staff do not allow resident out of his room” 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 Manager Rodolfo Lozada (S1).

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025

LIC9099 (FAS) - (06/04)

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