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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701540
Report Date: 11/17/2025
Date Signed: 11/17/2025 01:52:50 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
11/14/2025 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251114134240
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: 63DATE:
11/17/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Farial Shokoor TIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility staff are not following admission agreement
INVESTIGATION FINDINGS:
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On 11/17/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA met with Facility Designated Administrator (FDA), Farial Shokoor 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 against it at this time.
Current census was 63. A brief interview with FDA Shokoor was conducted.
It was alleged that the facility staff do not follow the facility admission agreement. During the course of this investigation, LPA conducted interviews and reviewed facility records.
Based on interviews conducted, it was denied that the facility staff are not following the admissions agreement regarding transportation services. It was stated by facility staff that all resident's are welcome to obtain transportation services through the facility. In addition, the facility staff responsible for driving the residents state that they are able to transport both ambulatory and non-ambulatory residents.
Futhermore, a review of the facilities records show that the facility does provide the facility transportation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2025
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-20251114134240
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: 11/17/2025
NARRATIVE
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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: 11/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2