198601924-5-3-2022-11-AS-JHAD-CERVRP-20220525164015

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601924
Report Date: 05/03/2022
Date Signed: 05/03/2022 12:15:30 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/28/2022 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220228104733

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:	05/03/2022
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Cathy Espina, Assistant Administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Resident is being financially abused while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegation listed above. Today’s complaint investigation was conducted with Cathy Espina, the facility assistant administrator.

The investigation consisted of following: Interviews and Record reviews. On 03/10/22, LPA Soto interviewed assistant administrator & R#1. Received the following documents on 03/10/22: Resident Roster, Staff Schedule Admissions agreement, Pre-Appraisals, Physician's Report, and Cash resources form for R#1 & R#2. Toured rooms #1, living room, kitchen, and dining room.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2022

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-20220228104733

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: GOLDEN CARE LIVING II	FACILITY NUMBER: 198601924
	VISIT DATE: 05/03/2022

NARRATIVE

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Based on the LPA's investigation, the investigation revealed the following. For Allegation – Resident is being financially abused while in care. LPA interviewed assistant administrator , S2, & S3, none of the staff ever handle money. They do not collect any form of money. They haven't even seen any of the residents handle any type of money. R1 is the only resident that handles his own finances. R1 has a bank account and R1 oversees R1's finances. The rest of the residents have family members that handle their finances. Interview with R1, stated that the bank is mishandling his finances and the staff does not help R1 with R1 finances. R1 writes checks to pay R1 rent. R1 has dementia and cannot remember a lot of things anymore. R1 does remember that R1 had a lot of money in the bank and the bank lost the money. R1's family member is trying to help R1 sort out R1's finances with the back, having trouble getting R1 to go with family member to sort the finances out. Interviews with R2, & R4, were not possible because R2 was asleep and R4 refused to speak with LPA. R3 stated that R3 liked the facility and R3's daughter handles R3's finances. LPA reviewed that R1 cash resources (hand written on form, (no cash handled)) and was shown bank checks and bank statement for R1. The bank statement showed low balance and no checks missing either. The checks have R1 signature, LPA compared the signature with R1 admissions agreement signature. The interviews and records reviewed do not concur with the above 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 unsubstantiated

An interview was conducted with Cathy Espina, Assistant Administrator, and a copy of report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2022

LIC9099 (FAS) - (06/04)

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