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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602067
Report Date: 03/19/2021
Date Signed: 03/19/2021 03:20:47 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:HOUSE OF GRACE LLCFACILITY NUMBER:
198602067
ADMINISTRATOR:MICHELLE AGUIRREFACILITY TYPE:
740
ADDRESS:618 RIDGEFIELD DRIVETELEPHONE:
(626) 716-1033
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY:6CENSUS: 4DATE:
03/19/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Michelle AguirreTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Glenn Trueman initiated a Plan of Correction (POC) visit. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s visit was conducted telephonically with Administrator Michelle Aguirre. LPA explained the reason for the call was to follow-up on the POC that was due on 3/10/21.

On 3/2/21, LPA delivered the substantiated findings for a complaint dated 1/07/21 (28-AS-20210107085253). The following allegation was substantiated; Licensee did not issue a refund in a timely manner.
The following regulation was cited on 3/2/21: HSC 1569.651(d).
The POC for this deficiency was submitted. Administrator submitted proof of check submitted to authorized representative.
Deficiency cleared.
No Civil Penalty Assessed.

This report was emailed for signature.
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn TruemanTELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2021
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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