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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601924
Report Date: 10/07/2022
Date Signed: 10/07/2022 04:14:20 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
10/03/2022 and conducted by Evaluator Jeremiah Randle
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20221003082813
FACILITY NAME:GOLDEN CARE LIVING IIFACILITY NUMBER:
198601924
ADMINISTRATOR:ANGELIQUE GRADNEYFACILITY TYPE:
740
ADDRESS:1854 EL REY ROADTELEPHONE:
(310) 989-1941
CITY:SAN PEDROSTATE: CAZIP CODE:
90732
CAPACITY:6CENSUS: 4DATE:
10/07/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:House Manager Bertin OkezieTIME COMPLETED:
04:01 PM
ALLEGATION(S):
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Facility's air conditioner is in disrepair.
INVESTIGATION FINDINGS:
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On or about 10/07/2022 9:00 a.m. Licensing Program Analyst (LPA) Jeremiah Randle conducted an unannounced complaint visit, regarding the allegation above at GOLDEN CARE LIVING II. LPA was met by facility House Manager Bertin Okezie (S1) the purpose of the visit was explained.
Investigation Consisted of the following:
Staff Interview (S1), Observation of Physical Plant inside and out, Record Review, and copies obtained of Pertinent documents pertaining to the allegation. LPA requested from the facility (Client Roster, Staff Roster) SIR’s/SOC 341, inclusive of all documents requested herein.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Jeremiah RandleTELEPHONE: (323) 213-1116
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022
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-20221003082813
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: GOLDEN CARE LIVING II
FACILITY NUMBER: 198601924
VISIT DATE: 10/07/2022
NARRATIVE
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Investigation Revealed the following.

Regarding Allegation: Facility's air conditioner is in disrepair. .

On 10/07/2022 LPA Randle interviewed House Manager Bertin Okezie (S1) (S1) provided statements that she is aware of the air conditioning unit being in the process of repair and a part is on order , However portable air conditioners/air coolers are on site and operational, as well as room fans and ceiling fans are located in each bedroom and common area. LPA also observed a new portable A/C unit scheduled to be installed on the current day. The facility temperature never reached above 85 degrees inside the facility. LPA interviewed R1- R2 all stated the temperature was comfortable in the facility.R3-R4 was sleeping during inspection

LPA concluded interviews with resident and staff and reviewed records. Based on interviews and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegation is found to be UNSUBSTANTIATED.

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 unsubstantiated

Exit interview held. A copy of the report was provided to the House Manager
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Jeremiah RandleTELEPHONE: (323) 213-1116
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2