198603118-2-4-2026-11-AS-SCIS-DRM3CZ-20260224170847

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603118
Report Date: 02/04/2026
Date Signed: 02/04/2026 02:52:01 PM

Unsubstantiated

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
01/30/2026 and conducted by Evaluator Felisa Shirley

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20260130134136

FACILITY NAME:	CLEARWATER AT SOUTH BAY		FACILITY NUMBER:	198603118
ADMINISTRATOR:	PAUL GOZON		FACILITY TYPE:	740
ADDRESS:	3210 & 3212 W SEPULVEDA BLVD		TELEPHONE:	(424) 488-6340
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90505
CAPACITY:	137	CENSUS: 105	DATE:	02/04/2026
		UNANNOUNCED	TIME BEGAN:	09:43 AM
MET WITH:	Paul Gozon, Executive Director		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not allow residents to select their hospice provider

INVESTIGATION FINDINGS:

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On 2/4/26, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced visit to this facility. LPA was met by the Executive Director, Paul Gozon and explained the purpose of the visit is to investigate and deliver findings for the allegations mentioned above. LPA was granted access to the facility.

The investigation consisted of the following:
On 2/4/26, LPA Shirley reviewed copies of the following records: Staff and Resident Roster, Hospice Provider Pamphlets, List of Referrals and List of Residents using Hospice Services. LPA Felisa Shirley conducted a tour of the facility. LPA Shirley interviewed Staff 1 – Staff-5 (S1 – S5), and Witness 1 – Witness 4 (W1-W4).

Con'd on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2026

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-20260130134136

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: CLEARWATER AT SOUTH BAY	FACILITY NUMBER: 198603118
	VISIT DATE: 02/04/2026

NARRATIVE

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The investigation revealed the following:

Allegation: Staff did not allow residents to select their hospice provider

It is being reported that the facility is restricting the ability of residents and families to choose their own hospice care. On 2/4/26, LPA Felisa Shirley requested the list of residents currently using hospice providers. LPA Shirley received a list of 8 residents, 2 residing in Assisted Living and 6 residing in Memory Care. During the investigation, LPA Shirley requested information regarding the hospice services the company uses. LPA Shirley received information packets from 11 different hospice providers. LPA Shirley observed that residents are utilizing varied hospice care providers. Per interview with S-2 on 2/4/26, Clearwater provides families with resources to make informed decisions about hospice care options.

LPA interviewed staff 1 – staff 5(S-1 – S-5). Of those interviewed 5 out of 5 denied the allegation. LPA interviewed witness 1 – witness 4 (W1 – W4). Of those who interviewed 4 out of 4 denied the allegation.

Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff did not allow residents to select their hospice provider,” therefore, the allegation is unsubstantiated.

No deficiencies were cited for these allegations.

An exit interview was conducted and a copy of this report was provided to the Executive Director, Paul Gozon.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2026

LIC9099 (FAS) - (06/04)

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