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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198205144
Report Date: 02/07/2024
Date Signed: 02/07/2024 03:47:57 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, 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
02/05/2024 and conducted by Evaluator Regina Cloyd
COMPLAINT CONTROL NUMBER: 11-AS-20240205141144
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: 4DATE:
02/07/2024
UNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Assistant Administrator Rodolfo "Ninyo" LozadaTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not safeguard resident's personal belongings.


INVESTIGATION FINDINGS:
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On 02/07/2024 Licensing Program Analyst (LPA) Regina Cloyd conducted a complaint investigation at the above facility to address the following allegations. LPA met with Caregiver LaVisitacion Carbonell and explained the purpose of the visit. Assistant Administrator Rodolfo "Ninyo" Lozada arrived 20 minutes later.

The investigation consisted of the following: During today’s investigation, LPA interviewed 4 out of 4residents and 4 staff which included the Assistant Administrator and (3) caregivers. LPA reviewed the resident records and staff training records.

Continue to LIC 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
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 5
Control Number 11-AS-20240205141144
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: SANTA FE HOME CARE HOMES
FACILITY NUMBER: 198205144
VISIT DATE: 02/07/2024
NARRATIVE
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The investigation revealed the following: Regarding the allegation "Staff did not safeguard resident's personal belongings," interviews conducted indicated the following: three out of four staff interviews agreed with the allegations. Over the phone, S4 confirmed with the Assistant Administrator that the allegation occurred. The Assistant Administrator asked S3 if the allegation occurred and S3 admitted to throwing contents away and apologized. Resident interviews conducted indicated the following: one out of four residents stated that their personal items are not protected, two out of four residents stated that their personal items are protected, and one out of four residents was unable to answer the question. Record reviews indicate that three out of four residents had a blank safeguards for property/valuables document on file with signature. Record reviews indicate that three out of three caregivers received training on residents’ rights. Regarding the allegation “Staff did not safeguard resident's personal belongings," based on interviews and observation, the preponderance of evidence has been met therefore the allegation is Substantiated.

Deficiencies were issued. An exit interview was conducted and plans of correction developed. A copy of this report and appeals rights was reviewed with Assistant Administrator Rodolfo "Ninyo" Lozada and left with Caregiver Dominador "David" Bonifacio.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20240205141144
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: SANTA FE HOME CARE HOMES
FACILITY NUMBER: 198205144
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/22/2024
Section Cited
CCR
87217(b)
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Safeguards for Resident Cash, Personal Property, and Valuables (b) Every facility shall take appropriate measures to safeguard residents'... personal property and valuables which have been entrusted to the licensee or facility staff. The...resources.
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The licensee will develop a plan of correction by the POC due date to ensure that all staff take appropriate measures to safeguard residents' personal property and valuables.
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This requirement was not met as evidenced by: Based on observations and interviews, the facility staff placed R1's personal property into the trash can without R1's permission.
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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: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
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, 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
02/05/2024 and conducted by Evaluator Regina Cloyd
COMPLAINT CONTROL NUMBER: 11-AS-20240205141144

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: 4DATE:
02/07/2024
UNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Assistant Administrator Rodolfo "Ninyo" LozadaTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff are threatening resident.
INVESTIGATION FINDINGS:
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On 02/07/2024 Licensing Program Analyst (LPA) Regina Cloyd conducted a complaint investigation at the above facility to address the following allegations. LPA met with Caregiver LaVisitacion Carbonell and explained the purpose of the visit. Assistant Administrator Rodolfo "Ninyo" Lozada arrived 20 minutes later.

The investigation consisted of the following: During today’s LPA interviewed 4 out of 4 residents and 4 staff which included the Assistant Administrator and (3) caregivers. LPA reviewed the resident records and staff training records.


Continue to LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
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-20240205141144
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: SANTA FE HOME CARE HOMES
FACILITY NUMBER: 198205144
VISIT DATE: 02/07/2024
NARRATIVE
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The investigation revealed the following: Regarding the allegation Staff are threatening resident," interviews conducted indicated the following: one out of four residents agreed with the allegation, three out of four residents disagree with the allegation, and three out of three staff members disagreed with the allegation. Record reviews indicate four out of four residents have a signed admission agreement which includes the eviction procedure. Based on the interviews, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated.

No deficiencies were cited. An exit interview was conducted. A copy of this report was reviewed with Assistant Administrator Rodolfo "Ninyo" Lozada and left with Caregiver Dominador "David" Bonifacio.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5