198603118-7-10-2025-11-AS-EMAZ-DLMTF2-20250918144050

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603118
Report Date: 07/10/2025
Date Signed: 07/10/2025 01:07:36 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
07/03/2025 and conducted by Evaluator Deborah Lee

COMPLAINT CONTROL NUMBER: 11-AS-20250703110413

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: 102	DATE:	07/10/2025
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Paul Gazon		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not ensuring all staff are criminally record cleared

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On July 10, 2025, Licensing Program Analyst (LPA) Deborah Lee conducted unannounced initial complaint visit regarding above allegation. LPA Lee met with Raul Gosan, Executive Director, and Raul Pereirra, Business Office Director, and explained the reason for the visit.

Investigation consisted of the following:

On 7/10/25, LPA obtained copies of the LIC 500 (dated 6/23/25) LPA reviewed 10 staff files (S2-S11), LPA conducted 2 staff interviews with Executive Director (A1) and Business of Director (S1). LPA and Business Office Director toured the facility.

Page 1 of 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025

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 2

Control Number 11-AS-20250703110413

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: 07/10/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The investigation revealed the following:

Allegation: Staff are not ensuring all staff are criminally record cleared

The complaint alleges that “applicants are being hired and are being scheduled on the floor before having and passing a live scan and physical/medical testing.” On 07/10/25, at 9:30am, LPA Lee interviewed the Executive Director (A1) who denied the allegation stating that all applicants are criminally and medically cleared before they are able to work on the floor.
On 7/10/25 at 10:30am LPA interviewed the Business Office Director (S1) who denied the allegation stating that he personally makes sure all applicants are criminally and medically cleared before hire.

On 7/10/25, LPA reviewed the staff roster/schedule (6/23/25), and cross checked with the Department’s Personnel Report Summary (LIS) and did not observe any discrepancies

On 7/10/25, LPA reviewed 10 staff files (S2-S11) and of those reviewed, 10 out of 10 had all required criminal clearance and medical clearance documents including TB/chest X-rays. Each staff file reviewed was in compliance with Title 22 regulations and had the required documentation.

Based on records reviewed and interviews conducted, there is insufficient evidence to support the allegation that Staff are not ensuring all staff are criminally record cleared. 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 interviewed conduct and report provided to Executive Director, Paul Gozon. No deficiencies cited during today's visit.

Page 2 of 2

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2