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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604764
Report Date: 02/04/2026
Date Signed: 02/04/2026 09:06:36 PM

Substantiated


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
01/26/2026 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20260126101613
FACILITY NAME:GRACEFUL CARE HOMES #1FACILITY NUMBER:
374604764
ADMINISTRATOR:RAMI BRIKHOFACILITY TYPE:
735
ADDRESS:10404 LEN COURTTELEPHONE:
(619) 971-1230
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY:6CENSUS: 6DATE:
02/04/2026
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Caregiver Armon WorrellTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff provided client with unprescribed medication.
Facility did not provide client with medical care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Correia conducted an unannounced visit to initiate and conclude a complaint investigation. Upon arrival, LPA was greeted by facility caregiver Armon Worrell. LPA identified herself and explained the purpose of the visit.

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

On January 26, 2026, the Department received a complaint alleging that facility staff did not seek medical attention for Client (C1) after C1 sustained a wrist injury on January 22, 2026. It was further alleged that staff administered an over-the-counter (OTC) medication without a physician’s order. An interview with an outside source (OS1) corroborated that on January 23, 2026, C1’s wrist was wrapped in an Ace bandage and that C1 was in possession of OTC pain relief medication provided by staff.

[Continued on LIC9099C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
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)
Page: 1 of 3
Control Number 08-AS-20260126101613
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: 02/04/2026
NARRATIVE
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A review of facility records revealed that C1 is not permitted to self administer medication and that the OTC pain relief medication was not listed on C1’s physician’s orders. Additionally, a review of outside source records and interviews with C1 and outside sources (OS1 and OS2) disclosed that C1 went to the hospital on January 23, 2026; however, C1 interviews and records revealed that C1 called 911 independently. A record review confirmed that X-rays were performed, which revealed no fracture, and C1 was discharged back to the facility with a splint.

Based on the Department's investigation the evidence gathered during the investigation met the preponderance of evidence standard to prove the violations occurred. An exit interview was conducted with Caregiver Harrison, and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22 and LIC 9099D) will be provided at the conclusion of the visit.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
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)
Page: 2 of 3
Control Number 08-AS-20260126101613
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/06/2026
Section Cited
CCR
80075(a)
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80075(a) The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services, including arrangement for and/or provision of transportation to the nearest available services.

This requirement was not met as evidenced by:

This is an amended report of the original delivered on 2/4/2026
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The Licensee agreed to attend, along with all staff, a Community Care Licensing (CCL) certified training on the facility’s responsibilities regarding providing timely and appropriate medical attention to clients in care.
Proof of correction will be submitted to CCL by the POC due date.
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Based on outside source record reviews and outside source and client interviews C1 sustained an injury and wanted medical attention and had to call 911 themselves..

This posed an immediate health risk to 1 out of six clients in care.

*this is an amended version of the original version dated 2_4_2026.
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Type A
02/06/2026
Section Cited
CCR
80075(b)
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Health Related Services (b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.

This requirement was not met as evidenced by:
This is an amended report of the original delivered on 2/4/2026.
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The Licensee agreed to attend, along with all staff, a Community Care Licensing (CCL) certified training on the facility’s responsibilities regarding providing medication management to clients in care.

Proof of correction will be submitted to CCL by the POC due date.
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Based on record reviews from outside sources and staff interviews, it was determined that Client #1 (C1) was administered an over-the-counter (OTC) medication without a physician’s order on file.

This posed an immediate health risk to one (1) out of six (6) clients in care.

*this is an amended version of the original version dated 2_4_2026.
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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.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2026
LIC9099 (FAS) - (06/04)
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