392701540-8-22-2025-27-AS-LRIS-DKYSHH-20250828135333

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392701540
Report Date: 08/22/2025
Date Signed: 08/22/2025 12:44:32 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
08/19/2025 and conducted by Evaluator Arielle Pascua

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20250819094431

FACILITY NAME:	LIVING GRACE ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	392701540
ADMINISTRATOR:	FARIAL SHOKOOR		FACILITY TYPE:	740
ADDRESS:	1960 WEST LOWELL AVENUE		TELEPHONE:	(559) 313-8062
CITY:	TRACY	STATE: CA	ZIP CODE:	95376
CAPACITY:	88	CENSUS: 60	DATE:	08/22/2025
		UNANNOUNCED	TIME BEGAN:	09:33 AM
MET WITH:	Farial Shokoor		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff is smoking marijuana inside the facility.
Staff does not provide a safe environment for residents

INVESTIGATION FINDINGS:

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

On 08/22/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct a complaint visit. LPA was greeted by Facility Designated Administrator (FDA), Farial Shookor and explained the purpose of the visit. The purpose of this visit was to inform the facility and its representative that a complaint has been filed it against it at this time.

Current census was 60. A brief interview with FDA Shookor.
Allegation: Staff is smoking marijuana inside the facility
It was alleged that facility staff is smoking marijuana inside the facility. During the course of this investigation, LPA conducted interviews and observations. Based on interviews conducted with facility staff and residents, it was denied that they have ever smoked marijuana inside the facility or have seen any other facility staff smoking inside the facility. In addition, all staff and residents state that they do not smell marijuana inside the facility. It was also stated by facility staff that this community is a non-smoking community and could only smoke in the designated areas.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025

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 27-AS-20250819094431

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: 08/22/2025

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

Furthermore, LPA Pascua conducted a tour of the facility and did not any observe any smells of marijuana. It was also observed that the designated smoking area is outside of the facility at this time. Based on the information gathered, there is not a preponderance of evidence to prove that the facility staff smoke marijuana inside the facility.

Allegation: Staff does not provide a safe environment for residents
It was alleged that the facility staff do not provide a safe environment for the residents. During the course of this investigation, the department conducted interviews with staff and residents. Based on the interviews, 6 out of 7 residents expressed no concerns regarding the comfort of the environment. In fact, these residents stated they were content living in the facility. 5 facility staff members denied the allegations, stating that they communicate regularly regarding residents' needs and have not received any issues from family regarding this matter. Based on the information gathered, it is unclear if the facility staff do not provide a safe environment for residents.

Based on statements obtained, records review and observations during the investigation process, LPA was unable to corroborate the allegations. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred.

An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2