198601924-12-16-2022-11-AS-SCIS-CMY2KG-20230110162754

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601924
Report Date: 12/16/2022
Date Signed: 12/16/2022 11:55:58 AM

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 II		FACILITY NUMBER:	198601924
ADMINISTRATOR:	ANGELIQUE GRADNEY		FACILITY TYPE:	740
ADDRESS:	1854 EL REY ROAD		TELEPHONE:	(310) 989-1941
CITY:	SAN PEDRO	STATE: CA	ZIP CODE:	90732
CAPACITY:	6	CENSUS: 4	DATE:	12/16/2022
		UNANNOUNCED	TIME BEGAN:	09:44 AM
MET WITH:	Bertin Okezie House Manager		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Facility's air conditioner is in disrepair.

INVESTIGATION FINDINGS:

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This report serves as an amendment to clarify findings, it does not supersede the complaint investigation findings reflected on report created on 10-7-2022

On 10/07/2022 at 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 and the purpose of the visit was explained. LPA was allowed entrance into the facility.
Investigation consisted of the following:
On 10/7/2022 LPA Randle interviewed Staff one (S1) as well as interviewed or attempted to interview Residents 1-4 (R1-R4), conducted a walkthrough of the physical plant, reviewed facility records, and requested and received copies of the following facility records: client roster, staff roster, incident reports and SOC 341.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Jeremiah Randle	TELEPHONE: (323) 213-1116
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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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: 12/16/2022

NARRATIVE

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Investigation revealed the following.

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

On 10/07/2022 LPA Randle conducted a walkthrough of the physical plant. LPA observed the following: portable air conditioners, room and ceiling fans throughout the facility. LPA Randle also observed a new portable A/C unit. The facility temperature never reached above 85 degrees inside the facility. LPA Randle did not observe a centralized air conditioning system.

On 10/7/2022 LPA Randle interviewed house manager Bertin Okezie S1. S1 stated one of the portable air conditioning units had gone out, however the facility had back-up air conditioners in place that provided cooling to the facility. S1 also added that there was an additional large air conditioner dedicated to the large community room and that all bedrooms had fans as well as back up air conditioning. S1 stated the facility temperature had never reached over 85 degrees. LPA Randle attempted to interview R3-R4, but both were sleeping during the investigation. LPA Randle interviewed R1- R2, both residents stated the temperature was comfortable in the facility.

LPA concluded interviews with residents 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 House Manager Bertin Okezie

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Jeremiah Randle	TELEPHONE: (323) 213-1116
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2022

LIC9099 (FAS) - (06/04)

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