198205144-6-21-2024-11-AS-RORN-D8DQAM-20240822120011

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198205144
Report Date: 06/19/2024
Date Signed: 06/21/2024 09:34:06 AM

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
06/11/2024 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20240611161313

FACILITY NAME:	SANTA FE HOME CARE HOMES		FACILITY NUMBER:	198205144
ADMINISTRATOR:	ANGELIQUE GRADNEY		FACILITY TYPE:	740
ADDRESS:	2340 SANTA FE AVENUE		TELEPHONE:	(424) 488-2079
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90501
CAPACITY:	6	CENSUS: 4	DATE:	06/19/2024
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Angelique Gradney		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not ensure that resident exited the facility supervised

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Wednesday, June 19, 2024, Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met Licensee Angelique Gradney. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: Interviews were conducted with staff members 1-2 (S1-S2) and residents 1-2 (R1-R2). LPA Bunker was unable to interview residents 3-4 (R3-R4) due to their non-verbal status. S1-S2 stated residents are provided with care and supervision 24 hours a day, 7 days a week, 365 days a year. S1-S2 noted the facility has a live-in staff that is always on duty. S1-S2 and R1-R2 confirmed that this is not a locked facility and that residents are permitted to go out into the community. S1-S2 stated on Friday, June 7, 2024, resident signed out to go for a walk at 2:00 P.M., and returned at 2:10 P.M. The following morning, on Saturday, June 8, 2024, a neighbor came knocking on the front door and ringing the doorbell. See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

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 3

Control Number 11-AS-20240611161313

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: 06/19/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued LIC9099-C page 2

The neighbor reported that one of their residents was outside by himself and threw a dirty adult diaper into her front yard, as well as into another neighbor's front yard. S1-S2 stated residents have personal rights and that staff could not have prevented the resident from leaving the diaper behind. However, staff is willing to dispose of the diaper and ensure the neighbor that such incidents do not occur in the future.

Staff 2 Christian Espino and LPA Bunker toured the entire facility to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. No signs of neglect or abuse were observed during today's visit. LPA Bunker requested and reviewed residents' records, including sign-in/out log sheets, incident report, admission agreements, appraisal & needs service plans, physician's reports, progress notes, I.D., and emergency information. Licensee Angelique provided LPA Bunker with copies of supporting documents.

Allegation: Staff did not ensure that resident exited the facility supervised
Interviews with Staff 1-2 (S1-S2) and residents 1-2 (R1-R2) revealed that residents are allowed to exit the facility unsupervised as this is not a locked facility. S1-S2 and R1-R2 stated residents sign in and out and are allowed to go into the community when they leave the facility. S1-S2 stated staff are trained and competent to provide care and supervision to meet the resident's needs. S1 stated staff is receiving ongoing training.

S1-S2 and R1-R2 stated staff are always aware of residents' whereabouts when a resident leaves the facility. They also stated that residents always wear shoes and do not go outside barefoot. S2 stated he never told the neighbor that residents are not allowed outside by themselves. S2 stated he mentioned that the resident has PTSD and is a war veteran. S2 stated he never told the neighbor resident was aggressive. S1-S2 stated this is a 24-hour care facility that operates, 7 days a week, 365 days a year 24 hours a day, ensuring that residents are never left at the facility alone without supervision.

See continued LIC9099-C page 3

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20240611161313

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: 06/19/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued LIC9099-C page 3

Investigation revealed the following: Staff 1-2 (S1-S2) stated as a 24/7 operation, staff is available around the clock, every day of the year, guaranteeing that residents are never left unattended Residents 1-2 (R1-R2) stated staff is always available to assist residents and they were happy living at the facility. S1-S2 and R1-R2 stated staff is providing comfortable accommodations for the residents. S1-S2 stated their staff is a dedicated team providing the necessary care and supervision to ensure the safety of all residents. Staff stated that since the resident had signed out, they were unaware of the incident involving the dirty adult diaper and had no control over the resident's actions. S1-S2 reported counseling the resident and explaining throwing diapers in the neighbor's yard is unacceptable. The resident explained that he couldn't find a trash can but agreed to use the facility's trash can in the future.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the 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 deemed unsubstantiated.

A copy of the Complaint Investigation Report LIC9099, and LIC9099-C, was provided to the Licensee/Administrator Angelique Gradney.

There were no deficiencies cited.

Exit interview conducted.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3