<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701540
Report Date: 07/08/2025
Date Signed: 07/09/2025 02:33:32 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/13/2025 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250513114757
FACILITY NAME:LIVING GRACE ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
392701540
ADMINISTRATOR:BREMER, MARLENEFACILITY TYPE:
740
ADDRESS:1960 WEST LOWELL AVENUETELEPHONE:
(559) 313-8062
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:88CENSUS: 63DATE:
07/08/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Farial ShokoorTIME COMPLETED:
10:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not safeguard confidential resident information
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 07/08/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to deliver complaint findings. LPA met with Facility Designated Administrator (FDA), Farial Shokoor and explained the purpose of this visit. The purpose of this visit was to deliver complaint findings.

Current census was 63. A brief interview with FDA Shokoor was conducted.
During the course of this visit, LPA reviewed facility records and conducted interviews.

It was alleged that staff do not safeguard condifidential resident information. Based on interviews conducted with facility staff it was denied that the facility does not safeguard resident information and state that they understand the rules and regulations to ensure that resident information remains private. In addition, LPA reviewed facility communication logs through an electronic system which are not accessed to outside parties of the facility. Based on the information gathered, there is not sufficient evidence to prove that the staff do not safeguard confidential resident information. An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
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 1