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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197800725
Report Date: 08/22/2024
Date Signed: 08/22/2024 02:33:58 PM

Document Has Been Signed on 08/22/2024 02:33 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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:GRACE CARE CORPORATIONFACILITY NUMBER:
197800725
ADMINISTRATOR/
DIRECTOR:		AARON, RUTHFACILITY TYPE:
735
ADDRESS:317 E. 189TH ST.TELEPHONE:
(310) 527-2018
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 6CENSUS: 3DATE:
08/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:53 PM
MET WITH:Christopher Aaron TIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 08/22/24, at 12:53pm, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Stephanie Wright, Administrator, and later Christopher Aaron, Vice President, and the purpose of today’s visit was explained. The facility is licensed to operate for (6) non-ambulatory, (Developmentally Disabled Adults) ages 18 through 59. Currently, the facility has (3) clients. The clients are South Central Los Angeles Regional Center clients. None of the clients have Restricted Health Care Conditions and none are utilizing postural supports or protective devices. The facilities annual fees for $681.00 were paid during the inspection.

The facility is a single-story family home located in a residential neighborhood. The facility consists of the following: (4) client bedrooms, (1) office, (2) bathrooms, living room, dining area, kitchen, laundry room and outdoor patio with chairs.

LPA conducted a records review of (3) client records, (6) staff records, (3) clients Personal & Incidental Records and reviewed the facility disaster plan. All client & Staff records were complete. The facility disaster plan was current and in compliance with Title 22 at the time of visit. LPA reviewed (3) Client Medication Administration Records and did not observe any discrepancies at the time of visit.

At 1:00pm, LPA toured the physical plant along with staff. There were no bodies of water, firearms, or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for resident personal belongings is available. Bed linens, comforters, and bath towels were adequately stocked at the time of the visit. Bathrooms were found to be within Title 22 regulations. Toilets and water faucets worked properly. Shower was free of mold/mildew, there is adequate lighting, and sufficient toiletries accessible to clients. The water temperature measured 114.4 F. A comfortable temperature was maintained in the facility.

Report continued on LIC 809-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: GRACE CARE CORPORATION
FACILITY NUMBER: 197800725
VISIT DATE: 08/22/2024
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LPA observed the facility to be sanitary and appropriately furnished at the time of the visit. Storage areas for personal hygiene were stored and not accessible to residents. The kitchen was inspected and there is enough perishable and non-perishable food available at the time of the visit. Carbon monoxide detector was observed and operational. Smoke detectors were working properly, and fire extinguisher(s) were fully charged. Toxins and sharps were locked and inaccessible to clients. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. The last fire/emergency drill was conducted on 07/30/2024. A working landline telephone remains available.

During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and residents. LPA observed that sanitizing stations were in common areas and restrooms. LPA observed that the facility had the required postings, posted throughout the facility. LPA further observed the facility to have a 60-day supply of Personal Protective Equipment (PPE).

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

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time.

Exit interview held and a copy of the report was provided to Christopher Aaron, Vice President.

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

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
LIC809 (FAS) - (06/04)
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