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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700643
Report Date: 10/18/2024
Date Signed: 10/18/2024 10:08:40 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/18/2024 10:08 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:LIVING GRACE ELDER CARE INCFACILITY NUMBER:
194700643
ADMINISTRATOR/
DIRECTOR:		BERNADETTE PEREZFACILITY TYPE:
300
ADDRESS:3241 PINE AVETELEPHONE:
(414) 499-7700
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY: CENSUS: DATE:
10/18/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:17 AM
MET WITH:Bernadette Perez - LicenseeTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of Living Grace Elder Care Inc on 10/18/24 for a biennial inspection. Upon arrival, EA identified himself and was greeted by licensee Bernadette Perez. The proper posting of business hours and license was observed. 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 and informed her that no deficiencies were found.

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

LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2024
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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