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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607206
Report Date: 01/12/2024
Date Signed: 01/12/2024 03:03:13 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/29/2023 and conducted by Evaluator Wendy Gibbs
COMPLAINT CONTROL NUMBER: 11-AS-20230929114331
FACILITY NAME:GOLDEN CARE LIVING, INC.FACILITY NUMBER:
197607206
ADMINISTRATOR:ANGELIQUE S. GRADNEYFACILITY TYPE:
740
ADDRESS:2052 REDONDELA DRIVETELEPHONE:
(310) 989-1941
CITY:RANCHO PALOS VERDESSTATE: CAZIP CODE:
90275
CAPACITY:6CENSUS: 4DATE:
01/12/2024
UNANNOUNCEDTIME BEGAN:
01:53 PM
MET WITH:Rachel LugtuTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Licensee is not adequately addressing a cockroach infestation at the facility.
INVESTIGATION FINDINGS:
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On 01/12/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced visit to the facility listed above to deliver the finding of the complaint. LPA met with Staff, Rachel Lugtu, and explained the purpose of today's visit. During today's visit three (3) clients were present.
During today's visit, LPA conducted a facility tour, and received the most recent reciept form Aptive Enviromental, pest managment company
On the previous visit conducted on 10/09/23, LPA conducted a facility tour with staff, conducted interviews with staff (S1 and S2) and residents (R1-R3), and requested and received copies of documents pertinent to the investigation. LPA received the following documents: Staff Roster, Resident Roster, and Resident Face Sheets.
On 10/11/23, LPA received an emial from the Administrator containing the receipts from Aptive Enviromental, a pest control company.
On 10/23/23, LPA spoke with resident's responsible party regarding what they have observed while at the facility.
Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024
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 11-AS-20230929114331
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: GOLDEN CARE LIVING, INC.
FACILITY NUMBER: 197607206
VISIT DATE: 01/12/2024
NARRATIVE
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The investigation revealed the following:

Allegation: Licensee is not adequately addressing a cockroach infestation at the facility.
The allegation alleges that there have been cockroaches all around the facility since April 2023.
During a file review, LPA received and reviewed copies of the facilities receipts from Aptive Environmental, a pest control company that comes out and treats the facility for ants, cockroaches, fleas, and spiders. The receipts are from July, September, and December. During LPAs two visits to the facility, LPA did not observe insects in the home. During interviews with Residents (R1-R3), two (2) out of three (3) stated there have been insects in the home in the past, but has gotten better. During interviews with Residents Responsible Party, stated that the issue has gotten much better and that they haven't seen any insects in the facility is some time. During interviews with staff (S1 and S2) two (2) out of two (2) stated in the past they have seen insects in the facility, but has gotten better since there has been a pest control company coming out and providing services. Additionally, staff stated new cocking was done around the sink and counters and they ensure the facility is clean and laundry is done on a daily basis.
Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

During today's visit LPA did not observe or cite any deficiencies.

An exit interview was conducted with Staff, Rachel Lugtu, and a copy of this report was provided.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2