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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701540
Report Date: 05/29/2026
Date Signed: 06/02/2026 04:32:20 PM

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
04/17/2026 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260417110448
FACILITY NAME:LIVING GRACE ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
392701540
ADMINISTRATOR:MARLENE BREMERFACILITY TYPE:
740
ADDRESS:1960 WEST LOWELL AVENUETELEPHONE:
(209) 833-2200
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:88CENSUS: 67DATE:
05/29/2026
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Farial ShokoorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff is handling residents in a rough manner
INVESTIGATION FINDINGS:
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Unannounced complaint visit made out to this facility on 05/29/2026 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator, Farial Shokoor, who was briefly interviewed at this time.
Current census was 67 residents.
The purpose of this visit was to deliver the findings from this complaint investigation to this facility, and it's representative, at this time.
Based on interviews that were conducted during the course of this investigation, it was learned that staff person, S1, has been observed by facility staff to be aggressive and handled residents in a rough manner while attempting to provide adequate care and supervision.
It was learned that on several occasions, S1 was observed to grab and pull residents by their wrists in S1's attempts to redirect them to the restroom or to their designated rooms.
It was learned that on other occasions, S1 was observed to forcefully grab residents by their wrists and clothing while pulling them up when attempting to transfer them to their chairs.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026
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 3
Control Number 27-AS-20260417110448
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: 05/29/2026
NARRATIVE
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It was learned that staff person S1 was observed by other facility staff persons to push and shove residents in care while attempting to redirect them or while attempting to assist them.
It was learned that staff person S1 disregarded personal safety for a facility resident who required the use of a wheelchair and was pushing this resident by only using the back two wheels of the wheelchair while the front wheels were suspended in the air.
Based on the statements and information gathered during the course of these interviews conducted, it was determined that staff person S1 did handle residents in a rough manner and even went so far as to jeopardize the safety and well being of the residents in care.

As a result of this investigation, this LPA found the allegation 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 observed and cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes.

Appeal rights were printed and a copy was left with the facility designated Administrator at this time.

Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20260417110448
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: 05/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/30/2026
Section Cited
CCR
87468.1(a)(1)(2)
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Residents in all residential care facilities for the elderly shall have all of the following personal rights:
To be accorded dignity in their personal relationships with staff, residents, and other persons. To be accorded safe, healthful and comfortable accommodations, furnishings
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The facility designated Administrator stated that all facility staff will be in-serviced, for no less than 2 hours in duration, on the topics of proper transfer of residents and maintaining the integrity of personal rights at all times. A statement of correction, along with proof of proper training, will be completed and
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and equipment.
This facility was found to be deficient as evidenced by the rough handling of facility residents and instances of putting residents in hazardous situations by facility staff. This posed an immediate threat to the Health, Safety, and Personal Rights of all residents in care.
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submitted into CCL by the due date for review by this LPA.
Proper Training will include the topics of training with duration, name of trainer(s), and a list of all attendees.
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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: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3