374604764-5-29-2025-08-AS-APAO-DHGLVY-20250609090619

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604764
Report Date: 05/29/2025
Date Signed: 05/29/2025 07:53:58 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/30/2025 and conducted by Evaluator Debbie Correia

COMPLAINT CONTROL NUMBER: 08-AS-20250130112642

FACILITY NAME:	GRACEFUL CARE HOMES #1		FACILITY NUMBER:	374604764
ADMINISTRATOR:	RAMI BRIKHO		FACILITY TYPE:	735
ADDRESS:	10404 LEN COURT		TELEPHONE:	(619) 971-1230
CITY:	SANTEE	STATE: CA	ZIP CODE:	92071
CAPACITY:	6	CENSUS: 3	DATE:	05/29/2025
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Caregiver Worrell		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Staff did not address a change in resident's condition.
Staff threatened client.
Staff are limiting resident’s visits.
Staff did not prevent an altercation between clients.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to deliver investigative findings on the above listed complaint allegations. LPA Correia met with Caregiver Worrell to whom was explained the purpose for the visit.

The Department’s investigation consisted of interviews with staff and outside sources, and a client records review.

It was alleged staff did not address a change in a client's condition. More specifically, it was alleged facility staff did not address side effects (sleepiness) of a newly prescribed medication by Client's1 (C1) Physician. It was also alleged the Licensee threatened to evict C1 if they did not take their medication. A client records review revealed C1 was admitted to the facility on October 23, 2024, and was their own Responsible Party (RP). Records also revealed C1 had several diagnoses including Epilepsy, Attention Hyperactivity Attention Disorder (ADHD), Autism, and Schizophrenia. Interviews conducted with facility staff (S1, S2, and S3) disclosed C1 was never threatened but encouraged to take their medication because C1 would begin to display severe behaviors when they were not appropriately medicated.

[Continued on LIC9099C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025

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 08-AS-20250130112642

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: GRACEFUL CARE HOMES #1	FACILITY NUMBER: 374604764
	VISIT DATE: 05/29/2025

NARRATIVE

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[Continuation of LIC9099]

The interview with S2 also revealed C1 was not compliant with taking their daily medication and agreed to a monthly shot in lieu of a daily dose. An interview conducted with Outside Source1 (OS1) revealed C1 was supposed to go to their Physician’s office once a month to receive an injection of the monthly medication however, would only come every other month. The interview with OS1 also corroborated that without taking their medication C1 would fall into a state of paranoid psychosis causing extreme behaviors.

Additionally, it was alleged that staff limited C1’s visitation rights. Interviews conducted with several outside sources (OS1, OS2, and OS3), as well as facility staff (S1, S2, and S3) all corroborated it was C1’s personal choice to limit their visitations. Facility staff also revealed visits would trigger C1’s behaviors and upset and agitate the other clients in care and disrupt the facility. Lastly, it was alleged that staff did not prevent an altercation between two clients. Interviews conducted with facility staff all corroborated the altercation involved C1 shoving Client2 (C2) that was quickly resolved by redirection provided by facility staff.

Based on staff and outside source interviews the above-mentioned allegations were determined to be unsubstantiated. This finding means there is not a preponderance of evidence to prove that the alleged violations occurred. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC9058 03/22) will be provided to Caregiver Worrell whose signature below confirms receipt of these rights.

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025

LIC9099 (FAS) - (06/04)

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