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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306090049
Report Date: 05/15/2024
Date Signed: 05/15/2024 04:19:03 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/07/2024 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240507092306
FACILITY NAME:GRACE RETIREMENT VILLAGEFACILITY NUMBER:
306090049
ADMINISTRATOR:CRYSEL SANTOSFACILITY TYPE:
740
ADDRESS:1100 E. WHITTIER BLVD.TELEPHONE:
(562) 694-6515
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:340CENSUS: 112DATE:
05/15/2024
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Michelle SongTIME COMPLETED:
04:33 PM
ALLEGATION(S):
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Staff did not follow proper food handling techniques
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegation. LPA met with Assistant Administrator (AA) Michelle Song and explained the reason for today’s inspection.

The investigation into the allegation that staff did not follow proper food handling techniques revealed the following: During the course of the investigation, LPA inspected the facility, interviewed residents, staff, and witnesses, and obtained and reviewed copies of the resident roster and staff roster.

Regarding the allegation that staff did not follow proper food handling techniques: it was alleged that a witness observed staff giving one resident’s leftover food that they had started eating but did not finish to another resident because the kitchen had run out of that particular food item. LPA interviewed the witness who identified the staff at issue. LPA interviewed the staff at issue who denied the allegation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024
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 22-AS-20240507092306
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: GRACE RETIREMENT VILLAGE
FACILITY NUMBER: 306090049
VISIT DATE: 05/15/2024
NARRATIVE
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LPA inspected the kitchen and observed it to be clean and organized, the refrigerator and freezer were at proper temperatures, and the facility has a two-day supply of perishables and a seven-day supply of non-perishable food is available as required by regulations. LPA interviewed six additional staff, including three kitchen staff and three caregivers, one of whom was unable to provide information due to a language barrier. These staff stated that the facility cooks enough food for the residents’ meals, the facility does not run out of food during meals, there is extra food during meals, and facility staff do not give food that was already served to another resident. LPA also observed two large food serving trays containing dozens of the residents’ plates from lunch that was served recently and noted a large amount of food leftover on the plates, which corroborates that the facility makes and serves enough food and would not need to re-serve food that was already served to a resident as a regular practice. LPA interviewed six residents and did not obtain information corroborating the allegation. The information obtained is conflicting.

Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2