198602864-3-26-2025-11-AS-UCOL-DFTRH6-20250417130150

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602864
Report Date: 03/26/2025
Date Signed: 03/26/2025 04:33:19 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, 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
03/20/2025 and conducted by Evaluator Socorro Leandro

COMPLAINT CONTROL NUMBER: 11-AS-20250320143906

FACILITY NAME:	SENIOR MANOR CARE		FACILITY NUMBER:	198602864
ADMINISTRATOR:	STEVEN GRADNEY		FACILITY TYPE:	740
ADDRESS:	2011 SANTA RENA DRIVE		TELEPHONE:	(310) 989-1941
CITY:	RANCHO PALOS VERDES	STATE: CA	ZIP CODE:	90275
CAPACITY:	6	CENSUS: 4	DATE:	03/26/2025
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Licensee/Administrator - STEPHEN GRADNEY		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

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Staff do not ensure that residents' dietary needs are met

INVESTIGATION FINDINGS:

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On 03/26/2025, the California Department of Social Services (CDSS) Community Care Community Care Licensing (CCL) Licensing Program Analyst (LPA) Socorro Leandro conducted an initial unannounced complaint visit. LPA Leandro met with Caregiver, Feri Sugarto the purpose of the visit was explained and LPA was granted entry to the facility.

The investigation consisted of the following:

On 03/26/2025, a facility tour was conducted, records were reviewed, and interviews were conducted. The facility tour consisted of touring the kitchen area. Interviews conducted consisted of 3 staff interviews [Staff (S1) to Staff 3 (S3) were interviewed] and 2 resident interviews [Resident 1 (R1) to Resident 2 (R2) were interviewed]. Facility records reviewed which consisted of Personnel Report, Register of Facility Residents, Meal Menus and Plan of Operation. Resident 3’s (R3) records were reviewed which consisted of Identification Emergency Information, Admission Agreement and Physicians Report.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025

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-20250320143906

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: SENIOR MANOR CARE	FACILITY NUMBER: 198602864
	VISIT DATE: 03/26/2025

NARRATIVE

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The investigation revealed the following:

Allegation: “Staff do not ensure that residents' dietary needs are met”, it is being alleged that there is not enough food in the facility for residents in care and residents do not receive enough food for each meal. Interviews conducted with R1 to R2 revealed the following: 1 out of 2 residents agreed with the allegation. Interviews conducted with S1 to S3 revealed the following: S1 indicated that the fridge does not have enough for the week. S2 indicated that the fridge is empty, sometimes there is not enough food in the facility and sometimes we (staff) use our own food to cook for residents in care. S3 indicated that that sometimes there is not enough food in the facility. On 3/26/2025 observations revealed the following: there were half empty shelves in the facility fridge and there was not enough perishable food items for a minimum of two days for 4 residents in care. (The facility has a total of 4 residents in care.) Records reviewed of the indicated The Plan of Operation under Food Service and Dietary Provisions states the following: “facility must ensure the availability of an adequate daily food intake for all residents”, thus, all residents must have enough food available to them that satisfies their hunger. Substantiated: Based on observations, interviews and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.

An exit interview was conducted, Plans of Corrections were reviewed and developed. A copy of this report and appeal rights were discussed and left with the Licensee/Administrator, Steven Gradney.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20250320143906

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: SENIOR MANOR CARE	FACILITY NUMBER: 198602864
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/26/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/15/2025 Section Cited CCR 87555(b)(26)	1 2 3 4 5 6 7	General Food Service Requirements (b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises.	1 2 3 4 5 6 7	On 3/26/2025, facility staff brought food to the facility which consisted of over 6 grocery bags. The Licensee/Administrator agrees to create a plan to maintain perishable foods for a minimum of two days. The licensee will re-train staff on meal procedures for seconds.
	8 9 10 11 12 13 14	Based on observation, interviews and records, the licensee did not comply with the section cited above in not having enough perishable food items for a minimum of two days for residents in care.	8 9 10 11 12 13 14	Email proof of correction to Socorro.Leandro@dss.ca.gov
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025

LIC9099 (FAS) - (06/04)

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