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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602274
Report Date: 01/14/2026
Date Signed: 01/14/2026 11:57:08 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/10/2025 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 11-AS-20250710130802
FACILITY NAME:SANTA FE HOME CARE IVFACILITY NUMBER:
198602274
ADMINISTRATOR:GRADNEY, ANGELIQUEFACILITY TYPE:
740
ADDRESS:5010 TORRANCE BLVDTELEPHONE:
(310) 316-0001
CITY:TORRANCESTATE: CAZIP CODE:
90503
CAPACITY:6CENSUS: 5DATE:
01/14/2026
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:House Manager - Nelson OrtegaTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Staff neglect.
INVESTIGATION FINDINGS:
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On 01/14/2025, Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced subsequent complaint investigation visit regarding the allegation listed above. LPA met with the House Manager, Nelson Ortega, and the purpose of the visit was explained. LPA was granted entry to the facility.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026
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 11-AS-20250710130802
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: SANTA FE HOME CARE IV
FACILITY NUMBER: 198602274
VISIT DATE: 01/14/2026
NARRATIVE
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Investigation consisted of the following:

On 07/11/2025, a facility tour was conducted, and records were gathered. Facility records were gathered which consisted of Resident Roster dated 06/01/2025 and Personnel Report dated 07/01/2025. Resident 1’s (R1) records were gathered which consisted of Admission Agreement dated 03/11/2020; Physicians Report dated 05/24/2024; Appraisal/Needs and Services Plan dated 05/12/2024; Resident Appraisal dated 03/21/2023; Identification and Emergency Information dated 03/22/2020; and other pertinent records were provided. On 07/23/2025, Staff 1 (S1) to Staff 3 (S3) were interviewed. On 09/26/2025, Staff 4 (S4) and Witness 1 (W1) were interviewed. On 10/14/2025, R1 was interviewed. On 10/15/2025, W1 and Witness 2 (W2) were interviewed. On 1/7/2026, Staff 2 (S2) to S3 and Resident 2 (R2) to Resident 5 (R5) were interviewed.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20250710130802
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: SANTA FE HOME CARE IV
FACILITY NUMBER: 198602274
VISIT DATE: 01/14/2026
NARRATIVE
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Investigation revealed the following:

Allegation: “Staff neglect”, it is being alleged that staff neglected R1. Personnel Report dated 07/01/2025 revealed the following: there were no staff on duty from 9:00 PM to 7:00 AM. R1’s records reviewed revealed the following: Admission Agreement dated 03/11/2020 indicates that R1 will receive “B. Basic services at a minimum include: 1. Continuous care and supervision…9. Assistance with personal activities of daily living as follows:…toileting…mobility tasks, and other personal care needs”. Physicians Report dated 05/24/2024 indicates that R1 has the following, dementia; motor impairment/paralysis; is confused/disoriented; not able to leave the facility unassisted; not able to provide own self-care such as grooming, care for own toileting needs, etc.; and non-ambulatory based on both physical and mental condition. Based on records reviewed the Licensee did not provide R1 with continuous care and supervision despite R1 requiring continuous care and supervision, due to that, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. An immediate $500 Civil Penalty is being assessed, please see LIC421IM.

An exit interview was conducted, and a plan of correction was developed. A copy of this report and appeal rights were provided to the House Manager, Nelson Ortega.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20250710130802
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SANTA FE HOME CARE IV
FACILITY NUMBER: 198602274
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/14/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/15/2026
Section Cited
CCR
87411(a)
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(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services.

This requirement is not met as evidenced by:
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The staff has agreed to re-read CCR87411(a). For residents that quire continuous care and supervision the staff has agreed to provide residents with 24-hour staff continuously working. The licensee will create a plan to provide residents with continuous care and supervision for residents that require it (based on physician’s reports, care plans, admission agreements, observations, etc.).
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Based on record review, R1 required continuous care and supervision, and the licensee did not have staff working between 9 PM to 7 AM thus, staff did not provide R1 with continuous care and supervision, which posed a potential health, safety or personal rights risk to persons in care.
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The licensee will email updated LIC500 and plan to Ulysses.Coronel@dss.ca.gov & Socorro.Leandro@dss.ca.gov
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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: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4