Senior Manor Care III

Type of visit: Required - 1 Year

On 08/21/26, the department conducted an unannounced required annual inspection using the Care Inspection Tool. The department met with staff, Nicholas Bana, and explained the purpose of the visit. The department was granted entry to the facility. The facility is licensed to serve six (6) non-ambulatory residents, of which one (1) may be bedridden. The facility has a hospice waiver approved for six (6) residents. Bedrooms #1, #2, and #4 are approved for non-ambulatory or bedridden residents. Currently there are six (6) residents in the facility. Facility’s annual fees are current. The facility is a single story structure located in a residential neighborhood and consists of the following: five (5) resident bedrooms, two and one half (2 ½) bathrooms, kitchen with office space, family room/activity area, dining room, staff bedroom, and an outside shaded patio. Outside grounds were toured and no bodies of water were observed. Patio furniture under a shaded area was accessible to residents. Walkways around the home were clear of hazards. The facility is clean, sanitary, and in good repair. There are no security bars or weapons on the premises. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Beds and bedding were in good condition, adequate lighting provided was observed. Walls and floors were clean and in good condition. Continued on LIC809-C Bathrooms were checked. Toilets and water faucets worked properly. Grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place. Hot water temperature properly measured between 105.0-12.0 degrees Fahrenheit. Bath towels, toiletries, and personal hygiene supplies were adequately stocked. The kitchen was inspected. The department observed supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Knives and toxins were kept in locked storage cabinet. First Aid kit, along with manual was available. One fire extinguisher was observed in the kitchen area, fully charged. Carbon monoxide and smoke detectors were operational. The department conducted a review of five (5) staff records The department conducted a review of six (6) client records, and three (3) Medication Administration Records (MAR), and observed them to be complete and in order, with no discrepancies. Medications were centrally stored and properly locked. Documents are posted as mandated. Last fire drill was conducted on 08/03/26. Annual fees are current. Liability insurance with Shomer Insurance Services, Policy #RN7032704103, effective 08/19/26, expires 08/19/27. Deficiencies cited, please see LIC809-D. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 21, 2026

Type of visit: Case Management - Other

On 07/23/2025, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced case management - other visit at this facility. LPA met with Staff who allowed for entry in this facility. LPA informed Staff the purpose of the visit is to conduct a case management - other visit in association with the noncompliance conference (NCC) with the Licensee on 11/24/2024. Administrator Stephen Gradney and Administrator Assistant Rodolfo "Nino" Lozada joined arrived shortly. During today's visit, 09/18/2025, LPA toured the facility and reviewed Resident #1's file. No deficiencies were observed. An exit interview was conducted and a copy of this report was left with Administrator Stephen Gradney.the state’s words, verbatim · CDSS document, Sep 18, 2025

Type of visit: Case Management - Other

On 07/23/2025, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced case management - other visit at this facility. LPA met with Staff who allowed for entry in this facility. LPA informed Staff the purpose of the visit is to conduct a case management - other visit in association with the noncompliance conference (NCC) with the Licensee on 11/24/2024. Administrator Assistant Rodolfo "Nino" Lozada and Angelique Gradney joined us later. The facility is licensed to serve six (6) non-ambulatory residents, of which one may be bedridden. The facility has a hospice waiver approved for six residents. Bedrooms #1, #2, and #4 are approved for non-ambulatory or bedridden residents. During today's visit, LPA conducted a tour in the kitchen and in bedrooms #3 and #5. LPA reviewed medical assessment for Resident #1 and Resident #2. LPA reviewed records for Staff #1 and Staff #2. No deficiencies were observed. An exit interview was conducted and a copy of this report was left with Angelique Gradney.the state’s words, verbatim · CDSS document, Jul 23, 2025

Type of visit: Case Management - Deficiencies

On 06/24/25, Licensing Program Manager (LPM) Ulysses Coronel and Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced case management – deficiency and met with Staff and explained the purpose of this visit. The purpose of this visit is to issue a deficiency observed on 06/06/25 and during today’s visit. On 06/06/25, Licensing Program Analyst (LPA) Regina Cloyd conducted a subsequent unannounced annual continuation and met with Staff. The facility is licensed to serve six (6) non-ambulatory residents, of which one may be bedridden. The facility has a hospice waiver approved for six residents. Bedrooms #1, #2, and #4 are approved for non-ambulatory or bedridden residents. Regional Office record review of the Fire Inspection Request by the Torrance Fire Department on 04/16/2019 indicates that only bedrooms #1, #2, and #4 are approved for non-ambulatory/bedridden residents. On 06/06/25, record review of register of residents revealed two non-ambulatory residents (R3 and R5) in rooms #3 and #5. Record review of medical assessment revealed R3 and R5 as non-ambulatory. Deficiencies are being cited based on record review in accordance with the California Code of Regulations, Title 22, see LIC809D. An immediate civil penalty of $500 is issued. An exit interview was conducted, plans of correction developed, and a copy of this report and appeal rights was discussed and left with Caregiver Rita Melindawati.the state’s words, verbatim · CDSS document, Jun 24, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Jun 25, 2025

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department,... Prior to accepting or retaining... persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance... This requirement was not met as evidence by Based on record review, bedrooms #1, #2, and #4 are approved for non-ambulatory or bedridden residents. Licensee accepted R3 and R5 (non-ambulatory) into ambulatory rooms (#3 and #5). This poses an immediate safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 24, 2025

Plan of correction: The Licensee agree to obtain a fire safety inspection to increase the number of rooms approved for non-ambulatory residents. The Licensee will create a plan, indicating specific steps to be taken by staff, based on the Fire Marshal’s guidance to ensure the residents’ safety.

Type of visit: Case Management - Annual Continuation

On 06/05/25, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection. On 06/06/25, LPA conducted a subsequent unannounced annual continuation and met with Staff. The facility is licensed to serve six (6) non-ambulatory residents, of which one may be bedridden. The facility has a hospice waiver approved for six residents. Bedrooms #1, #2, and #4 are approved for non-ambulatory or bedridden residents. Annual fees are current. The facility consists of five (5) resident bedrooms, two and one half (2 ½ ) bathrooms, kitchen with office space, family room/activity area, dining room, staff bedroom adjacent to the family room, and shaded patio. The facility is clean, sanitary, and in good repair. The Co-Administrator accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Beds and bedding were in good condition, adequate lighting provided, walls and floors were in good repair. Continue to LIC809-C. Bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, hot water temperature properly measured above 123 degree F and a hot water temperature warning sign was prominently placed. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean, clear of hazards, and doorways were free of obstructions. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxins were kept in locked storage cabinet. First Aid kit was available. One fire extinguisher, last serviced September 10, 2024 was observed in the kitchen area. Licensee tested the carbon monoxide detector and smoke detectors in the house. All devices were functional. Four (4) staff records were reviewed, four out of four staff records had required criminal record clearances or criminal record exemptions and first aid certificates. Five resident records were reviewed and, five out of five resident records had medical assessments and pre-appraisal. Two residents’ medication was reviewed. Deficiency was observed on 06/05/25 and cited from the California Code of Regulations, Title 22. 1. During record review, LPA did not observe TB results for Staff #2 (S2). Interview with S2 indicated that S2 has to complete the TB test. 2. During record review of facility sketch, it revealed rooms #3 and #5 as ambulatory. Record review of register of residents revealed two non-ambulatory residents (R3 and R5) in rooms #3 and #5. Record review of medical assessment revealed R3 and R5 as non-ambulatory. Continue to LIC809-C. An exit interview was conducted, plans of correction developed and reviewed, technical assistance provided, and a copy of this report with the appeals was discussed and left with the Co-Administrator Rodolfo "Nino" Lozada.the state’s words, verbatim · CDSS document, Jun 6, 2025

Allegation investigated: Staff did not seek timely medical care for resident.

On 11/13/2024, CDSS (California Department of Social Services) Staff conducted an unannounced complaint investigation for the allegation listed above. On 12/11/24, CDSS Staff resumed the investigation. On 06/05/25, CDSS conducted a subsequent unannounced visit to deliver findings and met with Co-Administrator Rodolfo "Nino" Lozada. The investigation consisted of the following: On 11/13/2024, CDSS Staff conducted resident and staff interviews, toured the facility, and reviewed resident and staff records. On 12/11/24, CDSS Staff interviewed staff, resident #1 (R1) and witness #1 (W1), reviewed facility records, and visited Torrance Memorial Medical Center to request records. On 02/13/25, CDSS Staff interviewed Witness #2 (W2) over the phone. On 02/27/25, CDSS Staff reviewed EMS report from Torrance City Clerk’s Office. On 05/23/2025, CDSS Staff obtained R1’s medical record from Torrance Memorial Medical Center. Continue to LIC9099-C. Substantiated Regarding the allegation "Facility staff did not seek timely medical care for resident,” It is being alleged that staff did not immediately call 911 after verifying that a resident was unresponsive. Records review revealed the following: Facility Daily Time Sheet revealed staff S2 and S3 were working at facility on 11/11/2024. The Emergency Medical Services report indicates that on 11/11/2024 at around 10:52am the paramedics arrived at the facility, observed that R1’s pulse was low and transported R1 to Torrance Memorial Hospital. Interviews indicate the following: S2 indicated that on 11/11/2024 around 9:00am, S2 observed R1 to be unresponsive. S2 and W2 attempted to wake R1 and W2 told S2 not to call 911 which S2 complied. S2 indicated that W1 arrived at 10:30am, attempted to wake R1, and then W1 called 911. S2 acknowledged S2 should have called 911 regardless of W2. W1 indicated finding out that R1 has been unresponsive for 90 minutes and W1 decided to call 911. On 02/13/25, CDSS Staff interview with W2 indicated S2 wanted to call 911 but W2 told S2 not to call. Regarding the allegation “Facility staff did not seek timely medical care for resident,” based on record reviews and interviews, the preponderance of evidence has been met therefore the allegation is Substantiated. Deficiencies were issued. An exit interview was conducted and plans of correction developed. A copy of this report, and appeals rights was reviewed and left with the Co-Administrator Rodolfo "Nino" Lozada.the state’s words, verbatim · CDSS document, Jun 5, 2025 · control 11-AS-20241112123745

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(g) · Plan of correction due date: Jun 6, 2025

Incidental Medical and Dental Care. (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement was not met by evidence by: Based on record review and interviews, Staff #2 (S2) did not immediately call 911 when S2 saw that Resident #1 was unresponsive. This posed an immediate risk to resident's health while in care.the state’s words, verbatim · CDSS document, Jun 5, 2025

Plan of correction: The Licensee will provide a plan of correction and email it to regina.cloyd@dss.ca.gov by the POC due date.

Type of visit: Required - 1 Year

On 06/05/25, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with Co-Administrator Rodolfo "Nino" Lozada. The facility is licensed to serve six (6) non-ambulatory residents, of which one may be bedridden. The facility has a hospice waiver approved for six residents. Bedrooms #1, #2, and #4 are approved for non-ambulatory or bedridden residents. The facility consists of five (5) resident bedrooms, two and one half (2 ½ ) bathrooms, kitchen with office space, family room/activity area, dining room, staff bedroom adjacent to the family room, and shaded patio. Annual fees are current. During the inspection, LPA toured the facility, reviewed facility and residents’ records, and resident medications. Deficiency was observed (see LIC809D) during today’s visit. Due to insufficient time, an annual continuation is required. An exit interview was conducted and a copy of this report was discussed and left with the Co-Administrator Rodolfo "Nino" Lozada.the state’s words, verbatim · CDSS document, Jun 5, 2025

Allegation investigated: Staff did not respond to resident's call bell in a timely manner.

On 5/7/25, at 9:40am, the department conducted a complaint visit to the facility and was greeted by Rodolfo Lozado, Administrator Assistant. The department explained the purpose of this visit is to gather information about the complaint, gather facility files, interview staff and residents, and deliver findings for the allegation mentioned above. The investigation consisted of the following: The department investigated the allegation mentioned in this complaint; and conducted interviews with staff (S1-S4) and resident (R1) from 10:00am-2:00pm. The department received the following: Resident Roster (Dated: 04/29/2025), Staff Roster (Dated: 4/21/2025), Pre-Placement Appraisals (Dated: 1/31/25, 3/1/25), ID/Emergency Information (Dated: 1/31/25, 5/8/24, 3/20/25), Resident Appraisal (Dated: 03/01/25), Admission Record (Dated: 7/2/24), Functional Capability Assessment (Dated: 3/1/25), Admission Agreement (Dated: 3/20/25), Incident Report (Dated: 4/20/25) and Physicians Reports (Dated: 01/31/25, 3/17/25), were obtained from the facility. Report Continued on LIC9099-C Unsubstantiated Allegation- Staff did not respond to resident’s call bell in a timely manner. It is alleged that staff allowed a resident who had fallen, to lay on the floor without giving the resident any assistance until 7:00am the following morning. It was reported that the resident called for assistance by pushing their call button at their bedside, but no one answered their call for assistance. On 05/7/25 from 10:00am-2:00pm the department interviewed staff (S1-S4) and resident (R1) about the allegation. 4 of 4 staff denied the allegation that the Staff did not respond to resident’s call bell in a timely manner. Staff stated that the resident did not have a fall, the resident slipped off the bed and needed assistance getting up. Staff stated that the resident rang the call bell, and they responded right away to the call. They stated that the resident pushed the bell around 6:30am, they went in to help and used a Hoyer Lift to get the resident on their feet and back in bed. They further state that the resident had no injuries, did not need first aid or medical treatment, and the facility submitted an incident report. The department interviewed resident (R1) about the allegation and 1 of 1 resident denied the allegation that Staff did not respond to resident’s call bell in a timely manner. Resident stated that the staff does respond to their call button and when they need assistance the staff does not take any more than five minutes to respond to their request. The resident further stated that they are satisfied with the care and supervision they are getting from the staff. The department reviewed the Incident Report (Dated: 4/20/25) and observed that the report was submitted, and the resident did not have or reported having any injuries or need for medical treatment. Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Staff did not respond to resident’s call bell in a timely manner. 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 issued. An exit interview was conducted with Rodolfo Lozado, Administrator Assistant, and a hard copy of this Complaint Investigation Report was provided.the state’s words, verbatim · CDSS document, May 7, 2025 · control 11-AS-20250429144945

Allegation investigated: Staff left resident in soiled diapers for an extended period of time. Staff did not ensure facility was free of pests. Staff did not notice residents change in condition. Staff raised the rent without proper notification. Staff did not provide resident with the admission agreement.

The investigation consisted of the following: On 11/13/2024, California Department of Social Services (CDSS) Staff conducted a complaint investigation at the above facility to address the following allegations. CDSS Staff met with Staff and explained the purpose of the visit. The Licensee Angelique Gradney and Administrator Virginia Asis joined us later. CDSS Staff conducted resident and staff interviews, toured the facility, and reviewed resident and staff records. Regarding the allegation "Staff left resident in soiled diapers for an extended period of time,” it is being alleged residents have been left in soiled diapers up to 14 hours on multiple occasions. Four out of four staff interviews indicated they change residents’ diapers on an average of 2-3 times per day or as needed. Interview with the Licensee indicated that Resident #1 (R1) is changed all of the time, and the majority of the facility’s incontinence changes are for R1. Continue to LIC9099-C. Unsubstantiated Five out of five resident interviews indicated that their diapers are changed 2-3 times per day or as needed. Resident #2 (R2) indicated that R2’s diaper is changed sometimes seven times a day. CDSS Staff did not observe the smell of incontinence in the facility. Regarding the allegation “Staff left resident in soiled diapers for an extended period of time," based on interviews and observations, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated. No deficiencies cited for this allegation. Allegation: Regarding the allegation "Staff did not ensure facility was free of pests,” it is being alleged the facility has cockroaches and rodents. Three out of three staff interviews indicated they have not seen any vermin or rodents in the facility. The Administrator and the Licensee indicated that the facility has not received any vermin or rodent complaints. Five out of five resident interviews indicated they have not seen any roaches in the facility. CDSS did not observe evidence of vermin nor pests during the facility tour. Regarding the allegation “Staff did not ensure facility was free of pests," based on interviews and observations, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated. No deficiencies cited for this allegation. Allegation: Regarding the allegation "Staff did not notice residents change in condition,” it is being alleged staff left Resident #1 (R1) unresponsive for an hour and a half. Interview with Staff #3 (S3) indicated S3 observed R1 being unresponsive. Interview with the Licensee indicated S3 informed Witness #2 (W2) of R1’s change of condition. Continue to LIC9099-C. Regarding the allegation “Staff did not notice residents change in condition," based on interviews, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated. No deficiencies are being cited. Allegation: Regarding the allegation "Staff raised the rent without proper notification,” it is being alleged that Resident #1’s (R1) rent increased from $4000 to $7000. Record review revealed R1’s admission agreement for Senior Manor Care III as of 04/16/2024 includes a monthly rate at $7,500. Interview with the Licensee indicated R1 moved into a small room (#3) at Senior Manor Care III for about three days but R1 wanted a larger private room (#4); thus the monthly rate increase from $4,200 to $7,500 (included incontinence). Licensee indicated that the current rate is based on the size of the room and the new charge did not go into effect until May 2024, but the correct rate is reflected in the admission agreement. Administrator indicated that the admission agreement was signed after R1 moved into the larger room. Monthly statements revealed a $4,200 (April 2024) charge and $7,500 (May - October 2024) charges. Full payments were made until September 2024. Five out of five resident interviews indicated they have not experienced a rate increase. Regarding the allegation “Staff raised the rent without proper notification," based on record reviews and interviews, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated. No deficiencies are being cited. Continue to LIC9099-C. Allegation: Regarding the allegation "Staff did not provide resident with the admission agreement,” it is being alleged that Resident #1 (R1) does not have a signed admission agreement. Record review revealed that Witness #1 (W1) is listed as the responsible person for R1 as of 04/16/2024, W1’s initials are recorded throughout the admission agreement and the agreement is signed by the resident’s responsible party. Interview with the Licensee indicated that W1 signed the admission agreement and received a copy. CDSS Staff observed the initials on admission agreement for Location #2 and Senior Manor Care III agreement are similar. Regarding the allegation “Staff did not provide resident with the admission agreement," based on record reviews, interviews, and observations, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegation. An exit interview was conducted and a copy of this report was provided to the Licensee Angelique Gradney.the state’s words, verbatim · CDSS document, Nov 13, 2024 · control 11-AS-20241112123745

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 06/29/24 at 9:13 AM, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with Staff and Licensee Angelique Gradney. The facility is licensed to serve six (6) non-ambulatory residents, of which one (1) may be bedridden. The facility has a hospice waiver approved for six (6) residents. The facility consists of four (4) resident bedrooms, three (3) bathrooms, kitchen, living room, dining area, office area, staff bedroom adjacent to the living room, and shaded patio. The facility is clean, sanitary, and in good repair. Staff accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. Residents' bedrooms had the required bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Beds and bedding were in good condition, adequate lighting provided, and walls and floors were in good repair. Residents' bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, hot water temperature measured at 124 F and a hot water temperature warning sign was prominently placed. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxics were kept in locked storage cabinet. First Aid kit was available. One fire extinguisher, last serviced August 2023 was observed in the kitchen area. Continue to LIC809-C. Licensee tested the carbon monoxide detector and smoke detectors in the house. Both devices were functional. Four (4) staff records were reviewed, 4 out of 4 staff records had required criminal record clearances or criminal record exemptions. Five (5) resident records were reviewed and, 5 out of 5 resident records had medical assessments and pre-appraisal. Two residents’ medication was reviewed. Deficiency was observed (see LIC809D) and cited from the California Code of Regulations, Title 22. Based on observation and record review, staff gave expired medication to a resident. An exit interview was conducted, plans of correction developed and reviewed, and a copy of this report and the appeals rights was discussed and left with the Licensee Angelique Gradney.the state’s words, verbatim · CDSS document, Jun 29, 2024