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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602274
Report Date: 07/21/2026
Date Signed: 07/21/2026 05:11:20 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/15/2026 and conducted by Evaluator Troy Watson
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20260615094658
FACILITY NAME:SANTA FE HOME CARE IVFACILITY NUMBER:
198602274
ADMINISTRATOR:GRADNEY, ANGELIQUEFACILITY TYPE:
740
ADDRESS:5010 TORRANCE BLVDTELEPHONE:
(310) 316-0001
CITY:TORRANCESTATE: CAZIP CODE:
90503
CAPACITY:6CENSUS: 6DATE:
07/21/2026
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:CARE GIVER - Resti Saragih TIME COMPLETED:
05:10 PM
ALLEGATION(S):
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Staff does not ensure residents privacy is protected.
INVESTIGATION FINDINGS:
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On 07/21/2026 Licensing Program Analyst (LPA) Troy Watson conducted a subsequent complaint visit to the facility listed above. LPA Watson was greeted by the Care Giver Resti Saragih and the purpose of the visit was explained. The LPA was granted entry into the facility.

Investigation consisted of the following:On 06/25/2026 the department requested and obtained the following documentation: Personnel Roster, Resident Roster. On 07/21/2026 the department requested and obtained the following documentation, Medical Administration Record for R1 dated 12/05/25 – 01/19/26, Initial Staff Training Requirements dated 10/28/24 – 11-25-24.The department interviewed Residents #4 and #6 (R1 and R6) and Staff#1–3# (S1-S3).An attempt was made to interview R1; however, R1 was no longer residing at the facility at the time the interviews were conducted. Attempts were also made to interview R2, R3, and R5, but all three residents are non verbal and unable to respond to interview questions.

CONTINUED ON LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026
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 6
Control Number 11-AS-20260615094658
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: SANTA FE HOME CARE IV
FACILITY NUMBER: 198602274
VISIT DATE: 07/21/2026
NARRATIVE
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Allegation: Staff does not ensure residents’ privacy is protected.

It is alleged that staff did not protect residents’ privacy and posted photos and videos of residents on social media.

The department conducted an interview with Licensee Angelique Gradney Staff#1 (S1). During the interview, S1 was asked if staff ensured residents privacy is protected. S1 stated that staff ensure residents’ privacy is protected. Regarding the facility’s policy on photos or videos, S1 explained that staff do not take any images of residents; only a third party may take pictures when needed for medical assessments.

An attempt was made to interview R1; however, R1 was no longer residing at the facility at the time the interviews were conducted. Attempts were also made to interview R2, R3, and R5, but all three residents are non-verbal and unable to respond to interview questions.

On 06/25/2026 between 09:15AM – 02:30 PM the department interviewed Residents #4 and #6 (R1 and R6). Out of those Residents interviewed (2) out of (2) denied the above allegation. On 06/25/2026 the department interviewed Staff#1–3# (S1-S3). Out of those staff interviewed (3) out of (3) denied the above allegation.

The department reviewed the facility staff’s social media page, and it showed pictures of residents posted without their permission. The department requested but could not obtain any documentation, or consent form signed by the residents, their power of attorney or conservator authorizing the use of their image or likeness. The posting of resident’s pictures without their consent is a violation of the resident’s personal rights.

Based on interviews and record reviews, the preponderance of evidence has been met; therefore, the allegation is Substantiated. California Code of Regulations, Title 22, Division 6, and Chapter 8 are being cited on the attached LIC9099-D

An exit interview was conducted with the House Manager Nelson Ortega, and a copy of this report was provided.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 11-AS-20260615094658
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SANTA FE HOME CARE IV
FACILITY NUMBER: 198602274
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/28/2026
Section Cited
CCR
87468.1(a)
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Residents in residential care facilities for the elderly shall have personal rights which include, but are not limited to, those listed in Sections 87468.1, Additional Personal Rights of Residents in Privately Operated Facilities, as applicable to the facility. (1) "Privately operated facility" means a residential care facility for the elderly that is licensed to an individual, firm, partnership, association, or corporation.
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Licensee shall provide all staff with training on personal rights of residence pertaining to the residents privacy. Licensee will provide copies of training materials and sign in sheet to the department by POC due date 07/28/26, via email to troy.watson@dss.ca.gov
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Based observation interviews, and social media observations, Staff posted pictures of R1 on social media without consent. This violation poses a personal rights and safety risk to residents in care.
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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.
SUPERVISOR'S NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/15/2026 and conducted by Evaluator Troy Watson
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20260615094658

FACILITY NAME:SANTA FE HOME CARE IVFACILITY NUMBER:
198602274
ADMINISTRATOR:GRADNEY, ANGELIQUEFACILITY TYPE:
740
ADDRESS:5010 TORRANCE BLVDTELEPHONE:
(310) 316-0001
CITY:TORRANCESTATE:CAZIP CODE:
90503
CAPACITY:6CENSUS: 6DATE:
07/21/2026
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:CARE GIVER - Resti Saragih TIME COMPLETED:
05:10 PM
ALLEGATION(S):
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Unqualified staff are administering insulin.
Staff interacts inappropriately with resident.
INVESTIGATION FINDINGS:
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On 07/21/2026 Licensing Program Analyst (LPA) Troy Watson conducted a subsequent complaint visit to the facility listed above. LPA Watson was greeted by the Care Giver Resti Saragih and the purpose of the visit was explained. The LPA was granted entry into the facility.

Investigation consisted of the following:

On 06/25/2026 the department requested and obtained the following documentation: Personnel Roster, Resident Roster. On 07/21/2026 the department requested and obtained the following documentation, Medical Administration Record for R1 dated 12/05/25 – 01/19/26, Initial Staff Training Requirements dated 10/28/24 – 11-25-24,

CONTINUED ON LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026
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 6
Control Number 11-AS-20260615094658
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: SANTA FE HOME CARE IV
FACILITY NUMBER: 198602274
VISIT DATE: 07/21/2026
NARRATIVE
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Investigation revealed the following:

Allegation: Unqualified staff are administering insulin.

It is alleged that unqualified staff were administering insulin to R1.

The department interviewed Licensee Angelique Gradney (S1). During the interview S1 was asked whether unqualified staff administer insulin, S1 stated no. S1 reported that only home health, hospice staff, family members, or self-administering residents handle insulin or diabetes medications. S1 confirmed they have never administered insulin injections.

An attempt was made to interview R1; however, R1 was no longer residing at the facility at the time the interviews were conducted. Attempts were also made to interview R2, R3, and R5, but all three residents are non-verbal and unable to respond to interview questions.

On 06/25/2026 between 09:15AM – 02:30 PM the department interviewed Residents #4 and #6 (R1 and R6). Out of those Residents interviewed (2) out of (2) denied the above allegation. On 06/25/2026 the department interviewed Staff#1–3# (S1-S3). Out of those staff interviewed (3) out of (3) denied the above allegation.

The department reviewed the Medical Administration Record (MAR) documentation for R1 dated 12/05/2025 to 01/19/2026 and it showed that R1 was not prescribed insulin nor was it administered to R1 at any time by the facility.

Based on the information gathered, interviews conducted, and an analysis of records reviewed, the department found no evidence to support the allegation “Unqualified staff are administering insulin”. 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.

CONTINUED ON LIC9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 11-AS-20260615094658
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: SANTA FE HOME CARE IV
FACILITY NUMBER: 198602274
VISIT DATE: 07/21/2026
NARRATIVE
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Allegation: Staff interact inappropriately with residents.

It is alleged that staff interacted inappropriately with a resident by engaging in conversations of a sexual nature.

The department conducted an interview with Licensee Angelique Gradney Staff#1 (S1). During the interview, S1 was asked if there have ever been instances of staff interacting inappropriately with residents. S1 reported they have never observed staff interacting inappropriately with residents. S1 stated that professional interactions are maintained through staff training provided by the house manager, use of training materials, and ongoing monitoring to ensure staff treat residents with care, respect, and appropriate communication.

An attempt was made to interview R1; however, R1 was no longer residing at the facility at the time the interviews were conducted. Attempts were also made to interview R2, R3, and R5, but all three residents are non-verbal and unable to respond to interview questions.

On 06/25/2026 between 09:15AM – 02:30 PM the department interviewed Residents #4 and #6 (R1 and R6). Out of those Residents interviewed (2) out of (2) denied the above allegation. On 06/25/2026 the department interviewed Staff#1–3# (S1-S3). Out of those staff interviewed (3) out of (3) denied the above allegation.

The department requested for but did not receive any Unusual Incident Reports or behavioral written documentation that showed staff inappropriately interacting with residents. The department observed the residents being treated with dignity and respect during the time of visit.

Based on the information gathered, interviews conducted, and an analysis of records reviewed, the department found no evidence to support the allegation “Staff interacts inappropriately with resident”. 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 exit interview was conducted with the administrator Virginia Asis, and a copy of this report was provided.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6