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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075601395
Report Date: 03/17/2022
Date Signed: 03/17/2022 04:03:55 PM


Document Has Been Signed on 03/17/2022 04:03 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:GRACE HOMES 2, LLCFACILITY NUMBER:
075601395
ADMINISTRATOR:HERBERT, HELEN GRACE S.FACILITY TYPE:
740
ADDRESS:423 MCLAUGHLIN STREETTELEPHONE:
(510) 233-5377
CITY:RICHMONDSTATE: CAZIP CODE:
94805
CAPACITY:6CENSUS: 5DATE:
03/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Administrator, Helen HerbertTIME COMPLETED:
04:15 PM
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On 3/17/2022 at 2:40pm, Licensing Program Analysts (LPAs) L. Holmes and L. Hall arrived unannounced to conduct an annual infection control inspection. LPAs met with Administrator, Helen Herbert and explained the reason for the visit..

LPAs toured the facility with Administrator, including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of four (4) bedrooms occupied by the residents, one (1) bedroom by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature was maintained at 69 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 107.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7-day supply of non-perishables, and a 2-day supply of perishable foods. First aid kit was observed to be complete.

Exit interview conducted and a copy of this report provided.

SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha HolmesTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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