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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700115
Report Date: 03/07/2025
Date Signed: 03/07/2025 11:14:27 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 03/07/2025 11:14 AM - It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
HOME CARE SERVICES, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:SAVING GRACE CARE, LLCFACILITY NUMBER:
194700115
ADMINISTRATOR/
DIRECTOR:		MONTANO, SANDRAFACILITY TYPE:
300
ADDRESS:3601 E. HOLT AVE UNIT ATELEPHONE:
(626) 475-8657
CITY:WEST COVINASTATE: CAZIP CODE:
91791
CAPACITY: CENSUS: DATE:
03/07/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Sandra Montano - LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of Saving Grace Care, LLC on 3/7/25 for a biennial inspection. Upon arrival, EA was greeted by Licensee Sandra Montano. The proper posting of business hours and license was observed. The proof of insurance's record was reviewed. EA was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review EA discussed the findings of the inspection with the licensee. EA informed the licensee of the deficiencies found and explained they would be noted on the 809D. Licensee was informed that home care aides without proof of clearance on the home care aide registry are not to be with clients.

EA Chan concluded the visit with an exit interview and provided a copy of this report along with appeal rights to the licensee.

LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
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Document Has Been Signed on 03/07/2025 11:14 AM - It Cannot Be Edited


Created By: Ryan Chan On 03/07/2025 at 10:49 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814

FACILITY NAME: SAVING GRACE CARE, LLC
FACILITY NUMBER: 194700115

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/22/2025
Section Cited
1796.43 (a)
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1796.43 (a)“Home care organizations that employ affiliated home care aides shall ensure the affiliated home care aides are cleared on the home care aide registry before placing the individual in direct contact with clients...”
This requirement is not met as evidenced by:
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Based on records reviewed licensee did not ensure home care aides (S1 through S11) were cleared on the home care aide registry before placing them with clients which poses an immediate risk to the health and safety of clients in care.
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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.
LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2025
LIC809 (FAS) - (06/04)
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