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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701540
Report Date: 04/27/2026
Date Signed: 04/27/2026 10:01:19 AM

Substantiated


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
10/16/2025 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251016124621
FACILITY NAME:LIVING GRACE ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
392701540
ADMINISTRATOR:FARIAL SHOKOORFACILITY TYPE:
740
ADDRESS:1960 WEST LOWELL AVENUETELEPHONE:
(209) 833-2200
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:88CENSUS: 69DATE:
04/27/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Farial ShokoorTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Facility is not financially solvent
INVESTIGATION FINDINGS:
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On 04/27/2026, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA Pascua met with Facility Designated Administrator (FDA), Farial Shokoor and explained the purpose of the visit. The purpose of the visit was to deliver complaint findings for the allegation above.

Current census was 69. A brief interview with FDA Shokoor was conducted.

It was alleged that the facility is not financially solvent. Based on information gathered during this investigation, it was learned that the September sample month Profit and Loss statement shows a net loss. The licensee did not provide documents to identify or support the actual revenues generated. The mortgage document and bank statement support that rent was paid, and it appears the licensee had control over the facility during the sample month reviewed.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026
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 4
Control Number 27-AS-20251016124621
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: LIVING GRACE ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 392701540
VISIT DATE: 04/27/2026
NARRATIVE
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The utility billing statements provided for PG&E, water, and Comcast show that the licensee made full payments consistently for the months reviewed. However, utility billing statements were not provided to determine the electricity payment history for the same period or to support the electricity expense listed on the operating statement. A working capital analysis performed for the sample month showed positive working capital. However, this is not considered reliable because the licensee did not report all current liabilities, including credit cards, and did not provide supporting documentation for current assets such as short-term receivables and notes. The review of the bank statements provided did not indicate that the licensee maintained, as required by law, the equivalent of at least one month of operating expenses.
The liability insurance certificate provided during the audit period shows that the facility met the required coverage per occurrence and aggregate per facility, as required by the Health and Safety Code. However, the liability insurance policy has since expired. The Certificate of Workers’ Compensation has also expired.
Overall, based on the records provided and reviewed, there is sufficient evidence to conclude that the facility is not financially solvent.
As a result of this investigation, the department found the allegations to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met.
The following deficiencies were cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes.

An exit interview was conducted, a copy of this report and appeals rights were provided to the facility at the end of this visit.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 27-AS-20251016124621
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LIVING GRACE ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 392701540
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/27/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/07/2026
Section Cited
CCR
87405(b)
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(b) The administrator of a facility or facilities shall have the responsibility and authority to carry out the policies of the licensee. This is not met as evidenced by:
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The facility has been placed on quarterly financial audit monitoring for 6 months. The Licensee will send the department documentation including: bank statements, profit & loss statements, balance sheets, utility bills, gas bills, worker’s compensation insurance.
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Based on record review, the licensee did not ensure that the facility administrator had the responsibility and authority to ensure that the facility was financially solvent. This poses a potential health, safety, and personal rights risks to persons in care.
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Documentation for the first quarter of the year will be sent to the LPA by 05/07/2026.
Type B
05/07/2026
Section Cited
CCR
87205(a)
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(a) The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations and the welfare of the individuals it serves. This is not met as evidenced by:
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The facility has been placed on quarterly financial audit monitoring for 6 months. The Licensee will send the department documentation including: bank statements, profit & loss statements, balance sheets, utility bills, gas bills, worker’s compensation insurance.
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Based on record review, the licensee did ensure that the facility was financially solvent. This poses a potential health, safety, and personal rights risks to persons in care.

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Documentation for the first quarter of the year will be sent to the LPA by 05/07/2026.
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: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 27-AS-20251016124621
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LIVING GRACE ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 392701540
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/27/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/07/2026
Section Cited
CCR
87213
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The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records; and shall submit such financial reports as may be required upon the written request of the licensing agency. Such request shall explain the need for disclosure. The licensing agency reserves the right to reject any financial report and to request additional information or examination including interim financial statements.
This is not met as evidenced by:
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The facility has been placed on quarterly financial audit monitoring for 6 months. The Licensee will send the department documentation including: bank statements, profit & loss statements, balance sheets, utility bills, gas bills, worker’s compensation insurance.
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Based on record review, the licensee did not ensure that the licensee had a financial plan and sufficient resources to meet operating costs for the facility, this poses a potential health, safety, and personal rights risks to persons in care.
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Documentation for the first quarter of the year will be sent to the LPA by 05/07/2026.
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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: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4