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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197800725
Report Date: 11/02/2022
Date Signed: 11/02/2022 01:58:42 PM

Document Has Been Signed on 11/02/2022 01:58 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:GRACE CARE CORPORATIONFACILITY NUMBER:
197800725
ADMINISTRATOR:AARON, RUTHFACILITY TYPE:
735
ADDRESS:317 E. 189TH ST.TELEPHONE:
(310) 527-2018
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 6CENSUS: 4DATE:
11/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Stephanie WrightTIME COMPLETED:
02:30 PM
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On 11/02/22 at 1:00 pm, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced Required- 1 Year visit, with a primary focus on infection control measures, using the new Care Inspection Tool. LPA met with staff, Stephanie Wright, and the purpose of the visit was explained. My temperature was taken and logged in a logbook. The facilities annual fees are currently past due with an outstanding amount of $681.00. The due date was 08/01/2022.


The facility is a single-story family home located in a residential neighborhood. There are currently four (4) residents in care with a capacity for six (6) developmentally disabled adults ages 18-59. At the time of the visit the residents were at their day program. The facility has four client bedrooms, one office, two bathrooms, living room, dining area, kitchen, laundry room and two outdoor areas with chairs.


As part of the inspection, my primary focus was on infection control. LPA observed the facility’s infection control practices: LPA observed a sanitizing station at the facility entrance. PPE supplies are readily available to staff and residents, and additional supplies are stored. Sufficient paper, cleaning, and disinfecting supplies were observed. The facility has the mandated COVID infection control posters.

Continue LIC 809C7
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: GRACE CARE CORPORATION
FACILITY NUMBER: 197800725
VISIT DATE: 11/02/2022
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LPA Scott and staff toured the physical plant, inspected client rooms, and bathrooms. The client bedrooms contain the required furniture and were inspected for safety, privacy, and comfort; and are complying in all areas. Additionally, LPA observed that the living areas, bathrooms, and kitchen were clean and operational. Smoke and carbon monoxide detectors were operable, fire extinguisher is fully charged, medications were centrally stored and properly locked in the kitchen cabinet. Ample supply of perishable and nonperishable food was observed. Fire extinguisher was last serviced on 11/01/22. And fire drill was performed on 09/20/22.

LPA observed that there were adequate linen and towel supply in the hall cabinet. No firearms were on the premises. Hazardous items are inaccessible to clients, yard was free of debris and hazards; and no bodies of water were present.

During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff and residents, sanitizing stations (Located in common areas and restrooms). LPA observed staff were wearing face coverings and required postings throughout the facility. LPA also observed that the facility has a 30-day supply of Personal Protective Equipment (PPE). And all mandated posters were posted.

LPA advised the Administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing (cdss.ca.gov) for Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance.

At the time of the visit Stephanie Wright logged onto the website to pay her required annual fees that included a late fee. Total amount of fees was $681.00.

No deficiencies noted or cited on this visit. A copy of the Facility Evaluation Report was given to Stephanie Wright, staff.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC809 (FAS) - (06/04)
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