198602274-1-7-2026-11-AS-UCOL-DVBRZJ-20260623132754

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602274
Report Date: 01/07/2026
Date Signed: 01/07/2026 02:48:57 PM

Unsubstantiated

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 IV		FACILITY NUMBER:	198602274
ADMINISTRATOR:	GRADNEY, ANGELIQUE		FACILITY TYPE:	740
ADDRESS:	5010 TORRANCE BLVD		TELEPHONE:	(310) 316-0001
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90503
CAPACITY:	6	CENSUS: 5	DATE:	01/07/2026
		UNANNOUNCED	TIME BEGAN:	10:22 AM
MET WITH:	House Manager - Nelson Ortega		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Resident sustained a fracture due to physical abuse.

INVESTIGATION FINDINGS:

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On 01/07/2025, 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.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2026

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: 01/07/2026

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, Resident 2 (R2) to Resident 5 (R5) were interviewed.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2026

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
	VISIT DATE: 01/07/2026

NARRATIVE

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Investigation revealed the following:

Allegation: “Resident sustained a fracture due to physical abuse.” Interviews conducted with R1 to R5 revealed the following: 3 out of 5 residents denied the allegation and 2 out of 5 resident interviews were inconclusive. Interviews conducted with S1 to S4 revealed the following: 4 out of 4 staff denied the allegation. Interviews conducted with W1 to W2 revealed the following: 2 out of 2 witnesses denied the allegation. R1’s records reviewed revealed the following: there were no hospital records, Unusual Incident Reports, nor a history of Adult Protective Services (APS) reports indicating that R1 has been physically abused in the facility. Observations on 07/11/2025 and 01/07/2026 revealed the following: there were no physical altercations nor abuse observed in the facility. Based on the department’s interviews, observations, and records reviewed this allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

No citations were provided.

An exit interview was conducted, and a copy of this report was left with the Caregiver, Resti Saragih.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2026

LIC9099 (FAS) - (06/04)

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