392701540-7-10-2025-27-AS-LRIS-DJGMF5-20250711093343

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392701540
Report Date: 07/08/2025
Date Signed: 07/10/2025 03:04:41 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/10/2025 and conducted by Evaluator Arielle Pascua

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20250610090810

FACILITY NAME:	LIVING GRACE ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	392701540
ADMINISTRATOR:	BREMER, MARLENE		FACILITY TYPE:	740
ADDRESS:	1960 WEST LOWELL AVENUE		TELEPHONE:	(559) 313-8062
CITY:	TRACY	STATE: CA	ZIP CODE:	95376
CAPACITY:	88	CENSUS: 63	DATE:	07/08/2025
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Farial Shokoor		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility staff do not answer call buttons on a timely manner
Facility staff left resident soiled for a long period of time
Resident rooms are not clean and sanitary
Facility staff did not wash resident's laundry

INVESTIGATION FINDINGS:

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On 07/08/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to deliver complaint findings. LPA met with Facility Designated Administrator (FDA), Farial Shokoor and explained the purpose of this visit. The purpose of this visit was to deliver complaint findings.

Current census was 63. A brief interview with FDA Shokoor was conducted.
During the course of this visit, LPA reviewed facility records, observations and conducted interviews.

Allegation: Facility staff do not answer call buttons on a timely manner.
It was alleged that the facility staff are not answering resident calls for assistance timely. During the course of this investigation, LPA conducted staff and resident interviews and reviewed facility documentation. An interview with 5 staff members were conducted. 5 out 5 staff members deny not answering resident call lights in a timely manner. 5 out 5 staff members state that the staff do a good job helping each other out and will assist a resident within 5-10 minutes.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025

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 3

Control Number 27-AS-20250610090810

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LIVING GRACE ASSISTED LIVING AND MEMORY CARE	FACILITY NUMBER: 392701540
	VISIT DATE: 07/08/2025

NARRATIVE

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An interview with 7 residents were conducted. 6 out of 7 residents report no issues with getting assistance in a reasonable time period when using their call lights. 1 out 7 residents were unable to answer the question due to medical reasons. A review of the facilities call button log from May-June 2025 show an average time of 5 minutes and 2 seconds. Based on the information gathered, it is unclear if the facility staff are not answering residents calls for assistance timely.

Allegation: Facility staff left resident soiled for a long period of time
It was alleged that the facility staff left residents soiled for a long period of time. During the course of this investigation, LPA Pascua conducted interviews with staff, residents and a family member. 7 of 7 residents interviewed all stated the staff assist them their needs when required, including their incontinence needs. The family member of the residents that was interviewed had no concerns regarding the care being provided at the facility. LPA Pascua conducted unannounced inspections on 3 separate occasions and did not detect incontinence odors. Based on the information gathered, there is not sufficient evidence to show that the facility staff left the resident soiled for a long period of time.

Allegation: Resident rooms are not clean and sanitary
It was alleged that the staff does not keep the facility clean and sanitary. During the course of the investigation, LPA Pascua conducted site visits and inspected the facility on 4 occasions. No unsanitary conditions were observed. LPA Pascua also interviewed a family member, 7 residents and 5 staff members, all of whom felt the facility is maintained in a sanitary condition. In addition, a review of the faciities housekeeping log shows that a deep clean is conducted on the days that the resident is scheduled for a shower. Cleaning is conducted on a as needed basis and could be daily. Based on the information gathered, there is not sufficient evidence to prove that the resident rooms are not clean and sanitary.

Allegation: Facility staff did not wash resident's laundry
It was alleged that the staff does not wash resident's laundry. During the course of the investigation, LPA Pascua conducted interviews and reviewed facility records. Based on interview with staff conducted revealed that each residents laundry is conducted once a week or as needed. Interviews with 5 residents disclose that they do not have any issues with their laundry services and are conducted as highlighted in their care plan. A review of the facilities laundry schedule confirms this statement. Based on the information gathered, there is not sufficient evidence to prove that the facility staff do not wash resident's laundry.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20250610090810

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LIVING GRACE ASSISTED LIVING AND MEMORY CARE	FACILITY NUMBER: 392701540
	VISIT DATE: 07/08/2025

NARRATIVE

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As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

There were no deficiencies observed or cited at this time.
An exit interview was conducted and a copy of this report were provided to the facility at the end of this visit.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025

LIC9099 (FAS) - (06/04)

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