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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198205144
Report Date: 06/19/2025
Date Signed: 06/19/2025 04:50:57 PM

Document Has Been Signed on 06/19/2025 04:50 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 HOMESFACILITY NUMBER:
198205144
ADMINISTRATOR/
DIRECTOR:		ANGELIQUE GRADNEYFACILITY TYPE:
740
ADDRESS:2340 SANTA FE AVENUETELEPHONE:
(424) 488-2079
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY: 6CENSUS: 6DATE:
06/19/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:57 AM
MET WITH:Administrator Designee Charesa ReyesTIME VISIT/
INSPECTION COMPLETED:
05:05 PM
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On 06/19/25, Licensing Program Analyst (LPA) Regina Cloyd conducted a Case Management - Other visit at this facility. LPA met with Staff who allowed for entry in this facility. LPA informed Staff the purpose of the visit is to conduct a case management - other visit in association with the noncompliance conference (NCC) with the Licensee on 11/24/2024. Administrator Designee Charesa Reyes joined later. The facility is licensed to serve four (4) non-ambulatory residents and two (2) ambulatory residents age 60 and over. Rooms #1 and #4 are for ambulatory residents and rooms #2 and #3 are for non-ambulatory residents.

During today's visit, LPA Cloyd toured rooms one and four and reviewed facility records, three staff records, and six resident records. Deficiencies are being cited based on observations, record reviews, and interviews in accordance with the California Code of Regulations, Title 22, see LIC809D. Civil Penalties will also be issued today.

Register of Facility Residents indicated the Resident #1 (R1) is non-ambulatory and lives in room #1 (for ambulatory residents only). R1's medical assessment (03/13/25) reveals resident to be bedridden. LPA observed R1 in hospital bed. Continue to LIC809-C.
NAME OF LICENSING PROGRAM MANAGER: Ulysses Coronel
NAME OF LICENSING PROGRAM ANALYST: Regina Cloyd
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 06/19/2025
NARRATIVE
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Register of Facility Residents indicate the Resident #2 (R2) is ambulatory and lives in room #1 (for ambulatory resident only). R2's medical assessment (03/17/25) indicated R2 as non-ambulatory. R2 was admitted to the facility on 03/18/25. LPA observed R2's bed in room #1.

Register of Facility Residents indicate that Resident #3 (R3) is non-ambulatory and lives in room #4 (for ambulatory residents only). R3's medical assessment (05/30/25) reveals resident to be non-ambulatory. LPA observed R3 in room #4. R3's Home Health Plan of Care (06/01/25 - 07/30/25) indicate R3 has a stage 3 wound. R3 was admitted to the facility on 06/01/25. As of 06/19/25, the Administrator Designee indicated that the wound is healed and Home Health will send an updated report in a few days. Administrator Designee indicated R3 is not on hospice. The facility did not have an exception request (for prohibited health condition) as specified on 87209 Program Flexibility.

Resident #4's (R4) Home Health Medication Profile (05/25/25 - 07/23/25) indicate R4 has a stage 4 ulcer on the right medial heel. R4 was admitted to the facility on 09/28/2017. Wound Specialist/Nurse Practitioner indicated that on 05/05/25, the unstageable wound was open and reclassified as stage 4. As of 06/19/25, the wound is still a stage 4. Administrator Designee indicated that R4 is not on hospice. The facility does not have an exception request (for prohibited health condition) as specified on 87209 Program Flexibility.

LPA reviewed three staff records and record review revealed Staff #2 (S2) was at the facility and not associated to the facility. S2 is listed on the Personnel Report dated 06/04/2025. This warrants a $500 civil penalty. See LIC421BG. Continue to LIC809-C.
NAME OF LICENSING PROGRAM MANAGER: Ulysses Coronel
NAME OF LICENSING PROGRAM ANALYST: Regina Cloyd
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 06/19/2025
NARRATIVE
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In addition to deficiencies cited, LPA will cite the Administrator (S1) for Administrator Qualifications 87405(d)(2) for not having knowledge and ability to conform to Title 22 Regulations on Limitations - Capacity and Ambulatory Status, Prohibited Health Conditions, and Criminal Record Clearance.

LPA reminded the Administrator Designee that a deficiency for Limitations - Capacity and Ambulatory Status was issued on 08/02/2024; therefore, warranting an immediate $250 civil penalty. See LIC421IM.

An exit interview was conducted, plans of correction were developed and reviewed, and a copy of this report with appeal rights was provided to the Administrator Designee Charesa Reyes.
NAME OF LICENSING PROGRAM MANAGER: Ulysses Coronel
NAME OF LICENSING PROGRAM ANALYST: Regina Cloyd
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/19/2025 04:50 PM - It Cannot Be Edited


Created By: Regina Cloyd On 06/19/2025 at 03:42 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 06/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/20/2025
Section Cited
CCR
87204(b)

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87204(b) Limitations - Capacity and Ambulatory Status (b) Resident rooms approved for 24-hour care of ambulatory residents only shall not accommodate nonambulatory residents. Residents whose condition becomes nonambulatory shall not remain in rooms restricted to ambulatory
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The Licensee wil email evidence of corrections to regina.cloyd@dss.ca.gov by the POC due date.
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residents. This requirement was not met by evidence of: During record review, interviews, and observation, R1, R2, and R3 are non-ambulatory and live in ambulatory rooms (#1 and #4). This poses a potential safety risk to residents in care. This is a repeated violation issued on 08/02/2024.
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Type B
06/24/2025
Section Cited
CCR87615(a)(1)

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87615(a)(1) Prohibited Health Conditions (a) Persons who require health services for or have a health condition including... shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. This requirement was not met by evidence:
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The Licensee will email a plan of correction to regina.cloyd@dss.ca.gov by the POC due date.
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During record review and interviews, R3 and R4 have stage 3 injuries upon admission/retention. The facility does not have a program exception request as specified in 87209 Program Flexbility. This poses a potential health 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.
Ulysses Coronel
NAME OF LICENSING PROGRAM MANAGER:
Regina Cloyd
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/19/2025 04:50 PM - It Cannot Be Edited


Created By: Regina Cloyd On 06/19/2025 at 04:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 06/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/24/2025
Section Cited
CCR
87355(e)(3)

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87355(e)(3) Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or
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The Licensee will email plan of correction to regina.cloyd@dss.ca.gov by the POC due date.
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This requirement was not met as evidence by: Record review of Guardian revealed that Staff #2 (S2) was not associated to the facility. This poses a potential safety risk to residents in care.
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Type B
06/24/2025
Section Cited
CCR87405(d)(2)

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Administrator - Qualifications and Duties (d) The administrator shall have... (2) Knowledge of and ability to conform to the applicable laws, rules and regulations.

This requirement was not met as evidence by:
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The Licensee will email plan of correction to regina.cloyd@dss.ca.gov by the POC due date.
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Based on interviews and record review, the Administrator (S1) was cited for Regulations on Limitations - Capacity and Ambulatory Status, Prohibited Health Conditions, and Criminal Record Clearance. This poses a potential health and safety 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.
Ulysses Coronel
NAME OF LICENSING PROGRAM MANAGER:
Regina Cloyd
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2025


LIC809 (FAS) - (06/04)
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