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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198205144
Report Date: 06/04/2025
Date Signed: 06/04/2025 02:22:10 PM

Substantiated


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
05/28/2025 and conducted by Evaluator Deborah Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250528092349
FACILITY NAME:SANTA FE HOME CARE HOMESFACILITY NUMBER:
198205144
ADMINISTRATOR:ANGELIQUE GRADNEYFACILITY TYPE:
740
ADDRESS:2340 SANTA FE AVENUETELEPHONE:
(424) 488-2079
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY:6CENSUS: 6DATE:
06/04/2025
UNANNOUNCEDTIME BEGAN:
07:59 AM
MET WITH:Charesa Reyes, Administrator DesigneeTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not provide an itemized receipt to resident for care services rendered
INVESTIGATION FINDINGS:
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On June 4, 2025, Licensing Program Analyst (LPA) Deborah Lee conducted a complaint visit regarding the above allegation. LPA Lee met with Charesa Reyes Administrator designee, and explained the reason for the visit. LPA spoke with Licensee Angelique Gradney via telephone who stated that Charesa will be the point person to provide any information needed for the investigation.

The investigation consisted of the following:
On June 4, 2025, LPA obtained and reviewed the following: staff roster (date 4/1/25), resident's roster (dated 6/1/25), Resident Appraisal for R1 (dated 3/12/25), Need and Services Plan for R1 (dated 3/12/25), Physician's Report for Residential Care for the Elderly (RCFE) for R1(dated 3/10/25), R1" signed personal rights LIC 613C (dated 3/12/25), signed Consent to a Medical Examination form (dated 3/12/25), Admission Agreement (dated 3/12/25), LPA reviewed R1 file. LPA conducted 1 staff interview—Administrator Designee (A1).

page 1 of 2
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
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 5
Control Number 11-AS-20250528092349
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 HOMES
FACILITY NUMBER: 198205144
VISIT DATE: 06/04/2025
NARRATIVE
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Investigation revealed the following:

Allegation: Staff did not provide an itemized receipt to resident for care services rendered.

The complaint alleges that "R1 paid a total amount of $10,500.00 for 1 ¾ months stay (3/12/25-5/3/25) and never received an itemized receipt for care services rendered." On 6/4/25 at 10:42am, LPA interviewed Administrator Designee (A1), Charesa Reyes who did not deny the allegation. A1 admitted that R1 was not provided an itemized receipt for her stay at the facility (3/12/25-5/3/25).

Based on LPAs interview and the review of records, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 Chapter 8 are being cited on the attached LIC 9099D.

Exit interview conducted and Copy of appeals rights and report provided to Charesa Reyes, Administrator Designee.

Page 2 of 2

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20250528092349
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 HOMES
FACILITY NUMBER: 198205144
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/11/2025
Section Cited
CCR
87208(a)(3)
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87208 (a)(3) Plan of Operation
The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. (3) Statement of admission policies and procedures regarding acceptance of persons for services.
This requirement was not met as evidenced by
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Administrator designee will submitt a written plan to LPA Deborah.Lee@dss.ca.gov via email by POC date 6/11/25 indicating how they will ensure future compliance of providing itemized receipts for residents upon receipt of payments.
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Based on record review and interviews, the licensee did not follow the payment provision section of their Plan of Operation by not providing R1 with an itemized receipt and billing statement upon receipt of payment which poses a potential Personal Rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
05/28/2025 and conducted by Evaluator Deborah Lee
COMPLAINT CONTROL NUMBER: 11-AS-20250528092349

FACILITY NAME:SANTA FE HOME CARE HOMESFACILITY NUMBER:
198205144
ADMINISTRATOR:ANGELIQUE GRADNEYFACILITY TYPE:
740
ADDRESS:2340 SANTA FE AVENUETELEPHONE:
(424) 488-2079
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY:6CENSUS: 6DATE:
06/04/2025
UNANNOUNCEDTIME BEGAN:
07:59 AM
MET WITH:Charesa Reyes, Administrator DesigneeTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not conduct a proper assessment of resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On June 4, 2025, Licensing Program Analyst (LPA) Deborah Lee conducted a complaint visit regarding the above allegation. LPA Lee met with Charesa Reyes Administrator designee, and explained the reason for the visit. LPA spoke with Licensee Angelique Gradney via telephone who stated that Charesa will be the point person to provide any information needed for the investigation.

The investigation consisted of the following:
On June 4, 2025, LPA obtained and reviewed the following: staff roster (date 4/1/25), resident's roster (dated 6/1/25), Resident Appraisal for R1 (dated 3/12/25), Need and Services Plan for R1 (dated 3/12/25), Physician's Report for Residential Care for the Elderly (RCFE) for R1(dated 3/10/25), R1" signed personal rights LIC 613C (dated 3/12/25), signed Consent to a Medical Examination form (dated 3/12/25), Admission Agreement (dated 3/12/25), LPA reviewed R1 file. LPA conducted 1 staff interview—Administrator Designee (A1).

page 1 of 2
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20250528092349
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 HOMES
FACILITY NUMBER: 198205144
VISIT DATE: 06/04/2025
NARRATIVE
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Investigation revealed the following:

Allegation: Staff did not conduct a proper assessment of resident

The complaint alleges that that R1 never got an assessment. On 6/4/25 at 10:42am, LPA interviewed Administrator Designee (A1), Charesa Reyes who denied allegation stating that R1 received a proper medical assessment including residential appraisal and Need and Services Plan.

On 6/4/25, LPA reviewed Physician's Report for Residential Care for the Elderly (RCFE) for R1(dated 3/10/25), Resident Appraisal for R1 (dated 3/12/25), Need and Services Plan for R1 (dated 3/12/25). The medical assessment LIC 602 was completed signed and dated.

Based on the information gathered, there is insufficient evidence to support the stated allegation.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANCIATED.

There were no deficiencies cited during today's visit.

Exit interview conducted and report provided to Charesa Reyes, Administrator Designee.

Page 2 of 2

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5