Community Care Licensing

SUPERVISOR'S NAME: Nedra Brown TELEPHONE: (951) 202-5776 LICENSING EVALUATOR NAME: Amy Goldenberg TELEPHONE: (951) 201-3990 LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023

Document Has Been Signed on 10/12/2023 02:20 PM - It Cannot Be Edited

FACILITY NAME: GRACIOUS CARE HOME	FACILITY NUMBER: 331880740
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/12/2023

Type A

Section Cited

CCR

87202(a)(2)

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: (2) Bedridden persons This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on review of resident records, the licensee did not comply with the section cited above. Resident #2 physician report dated 06/21/2023 indicates bedridden status. This facility does not have a room cleared for a bedridden individual included in the fire clearance, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/12/2023
	Plan of Correction
1 2 3 4	Licensee to contact local fire jurisdiction and notify of bedridden status of resident #2 and submit LIC200 to request bedridden fire clearance for bedroom.

Type A

Section Cited

CCR

87309(a)

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation, the licensee did not comply with the section cited above as evidenced by LPA observation of bleach and laundry soap unlocked and accessible to residents in the laundry room. This poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/13/2023
	Plan of Correction
1 2 3 4	Licensee to allocate a locked area for all cleaning solutions by POC due date 10/13/2023.

SUPERVISOR'S NAME: Nedra Brown TELEPHONE: (951) 202-5776 LICENSING EVALUATOR NAME: Amy Goldenberg TELEPHONE: (951) 201-3990 LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023

Document Has Been Signed on 10/12/2023 02:20 PM - It Cannot Be Edited

FACILITY NAME: GRACIOUS CARE HOME	FACILITY NUMBER: 331880740
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/12/2023

Type A

Section Cited

HSC

1569.618(c)(3)

(c) The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on review of records there are no training records available to verify that this requirement has been met.
	POC Due Date: 10/13/2023
	Plan of Correction
1 2 3 4	Licensee to conduct training and retain records by POC due date.

Section Cited

	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

SUPERVISOR'S NAME: Nedra Brown TELEPHONE: (951) 202-5776 LICENSING EVALUATOR NAME: Amy Goldenberg TELEPHONE: (951) 201-3990 LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023

Document Has Been Signed on 10/12/2023 02:20 PM - It Cannot Be Edited

FACILITY NAME: GRACIOUS CARE HOME	FACILITY NUMBER: 331880740
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/12/2023

Type A

Section Cited

CCR

87411(a)

(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on Caregiver Interview the licensee did not comply with the section cited above.Caregiver #1 is on duty 24 hours for 5 days straight without assistnce. This facility retains residents with a diagnosis of dementia. Resident #2 has two 1/2 bedrails on their bed and Caregiver #1 tells LPA that the resident moves around a lot at night and she fears that Resident #2 will fall. This poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/13/2023
	Plan of Correction
1 2 3 4	Licensee to ensure staffing is sufficient to monitor resident #2 by removing 2nd bed rail and employing an awake caregiver to adequately supervise Resident #2.

SUPERVISOR'S NAME: Nedra Brown TELEPHONE: (951) 202-5776 LICENSING EVALUATOR NAME: Amy Goldenberg TELEPHONE: (951) 201-3990 LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023

Document Has Been Signed on 10/12/2023 02:20 PM - It Cannot Be Edited

FACILITY NAME: GRACIOUS CARE HOME	FACILITY NUMBER: 331880740
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/12/2023

Type A

Section Cited

CCR

87412(e)

(e) In all cases, personnel records shall demonstrate adequate staff coverage necessary for facility operation by documenting the hours actually worked. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on Interview the licensee did not comply with the section cited above. Staff member #1 indicated that resident #2 is awake all night and may require supervision to not fall out of bed. There is no awake supervision provided on night shift. This poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/12/2023
	Plan of Correction
1 2 3 4	Licensee to provide CCL with updated staff schedule demonstrating adequate night supervision of residents with dementia.

Type A

Section Cited

HSC

1569.69(a)(3)

(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (3) An employee shall be required to complete the training requirements for hands-on shadowing training described in this subdivision prior to assisting any resident in the self-administration of medications. The training and instruction described in this subdivision shall be completed, in their entirety, within the first two weeks of employment. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on review of records there is no documentation on file to support that this requirement is met. This poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/19/2023
	Plan of Correction
1 2 3 4	Licensee to provide training to employees that dispense medications by POC due date 10/19/2023.

SUPERVISOR'S NAME: Nedra Brown TELEPHONE: (951) 202-5776 LICENSING EVALUATOR NAME: Amy Goldenberg TELEPHONE: (951) 201-3990 LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023

Document Has Been Signed on 10/12/2023 02:20 PM - It Cannot Be Edited

FACILITY NAME: GRACIOUS CARE HOME	FACILITY NUMBER: 331880740
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/12/2023

Type A

Section Cited

CCR

87465(h)(2)

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation. LPA observed that the medication cabinet lock does not prevent access to others. LPA was able to open the medication cabinet. It is only secured with a baby type device and is easily opened by non employees and residents. This poses a risk to the health and safety of the persons in care.
	POC Due Date: 10/13/2023
	Plan of Correction
1 2 3 4	Licensee to allocate a locked are for medications that rendes them inaccessible to persons other than employees responsible for supervision of the centrally stored medication by POC due date 10/13/2023.

Section Cited

	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

SUPERVISOR'S NAME: Nedra Brown TELEPHONE: (951) 202-5776 LICENSING EVALUATOR NAME: Amy Goldenberg TELEPHONE: (951) 201-3990 LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023

Document Has Been Signed on 10/12/2023 02:20 PM - It Cannot Be Edited

FACILITY NAME: GRACIOUS CARE HOME	FACILITY NUMBER: 331880740
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/12/2023

Type B

Section Cited

HSC

1569.153(b)

(b)  Orientation to the policies and procedures for all employees within 90 days of employment. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.
	POC Due Date: 10/19/2023
	Plan of Correction
1 2 3 4	Licensee will conduct and maintain training record by POC due date.

Type B

Section Cited

CCR

87411(d)

(d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.
	POC Due Date: 10/19/2023
	Plan of Correction
1 2 3 4	Licensee will conduct and maintain training records by POC due date.

SUPERVISOR'S NAME: Nedra Brown TELEPHONE: (951) 202-5776 LICENSING EVALUATOR NAME: Amy Goldenberg TELEPHONE: (951) 201-3990 LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023

Document Has Been Signed on 10/12/2023 02:20 PM - It Cannot Be Edited

FACILITY NAME: GRACIOUS CARE HOME	FACILITY NUMBER: 331880740
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/12/2023

Type B

Section Cited

CCR

87613(a)(2)(B)

(2) Ensure that facility staff who will participate in meeting the resident's specialized care needs complete training provided by a licensed professional sufficient to meet those needs. (B) Training shall be completed prior to the staff providing services to the resident. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.
	POC Due Date: 10/19/2023
	Plan of Correction
1 2 3 4	Licensee to conduct training and maintain training records by POC due date 10/19/2023.

Section Cited

	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

SUPERVISOR'S NAME: Nedra Brown TELEPHONE: (951) 202-5776 LICENSING EVALUATOR NAME: Amy Goldenberg TELEPHONE: (951) 201-3990 LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023

Document Has Been Signed on 10/12/2023 02:20 PM - It Cannot Be Edited

FACILITY NAME: GRACIOUS CARE HOME	FACILITY NUMBER: 331880740
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/12/2023

Type B

Section Cited

HSC

1569.625(b)(1)

(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.
	POC Due Date: 10/19/2023
	Plan of Correction
1 2 3 4	Licensee to conduct training and maintain training records by POC due date.

SUPERVISOR'S NAME: Nedra Brown TELEPHONE: (951) 202-5776 LICENSING EVALUATOR NAME: Amy Goldenberg TELEPHONE: (951) 201-3990 LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023

Document Has Been Signed on 10/12/2023 02:20 PM - It Cannot Be Edited

FACILITY NAME: GRACIOUS CARE HOME	FACILITY NUMBER: 331880740
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/12/2023

Type B

Section Cited

HSC

1569.625(b)(2)

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.
	POC Due Date: 10/19/2023
	Plan of Correction
1 2 3 4	Licensee to conduct training and maintain training record by POC due date.

Type B

Section Cited

HSC

1569.625(c)(1)

(c) The training shall include, but not be limited to, all of the following: (1) Physical limitations and needs of the elderly. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.
	POC Due Date: 10/19/2023
	Plan of Correction
1 2 3 4	Licensee to conduct training and maintain training record by POC due date.

SUPERVISOR'S NAME: Nedra Brown TELEPHONE: (951) 202-5776 LICENSING EVALUATOR NAME: Amy Goldenberg TELEPHONE: (951) 201-3990 LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023

Document Has Been Signed on 10/12/2023 02:20 PM - It Cannot Be Edited

FACILITY NAME: GRACIOUS CARE HOME	FACILITY NUMBER: 331880740
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/12/2023

Type B

Section Cited

HSC

1569.625(c)(2)

(c) The training shall include, but not be limited to, all of the following: (2) Importance and techniques for personal care services. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.
	POC Due Date: 10/19/2023
	Plan of Correction
1 2 3 4	Licensee to conduct training and maintain training record by POC due date.

Type B

Section Cited

HSC

1569.625(c)(3)

(c) The training shall include, but not be limited to, all of the following: (3) Residents’ rights. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.
	POC Due Date: 10/19/2023
	Plan of Correction
1 2 3 4	Licensee to conduct training and maintain trainng record by POC due date.

SUPERVISOR'S NAME: Nedra Brown TELEPHONE: (951) 202-5776 LICENSING EVALUATOR NAME: Amy Goldenberg TELEPHONE: (951) 201-3990 LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023

Document Has Been Signed on 10/12/2023 02:20 PM - It Cannot Be Edited

FACILITY NAME: GRACIOUS CARE HOME	FACILITY NUMBER: 331880740
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/12/2023

Type B

Section Cited

HSC

1569.625(c)(4)

(c) The training shall include, but not be limited to, all of the following: (4) Policies and procedures regarding medications. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.
	POC Due Date: 10/19/2023
	Plan of Correction
1 2 3 4	Licensee to conduct training and maintain training records by POC due date.

Type B

Section Cited

HSC

1569.625(c)(5)

(c) The training shall include, but not be limited to, all of the following: (5) Psychosocial needs of the elderly. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.
	POC Due Date: 10/19/2023
	Plan of Correction
1 2 3 4	Licensee to conduct training and maintain trainnig records by POC due date.

SUPERVISOR'S NAME: Nedra Brown TELEPHONE: (951) 202-5776 LICENSING EVALUATOR NAME: Amy Goldenberg TELEPHONE: (951) 201-3990 LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023

Document Has Been Signed on 10/12/2023 02:20 PM - It Cannot Be Edited

FACILITY NAME: GRACIOUS CARE HOME	FACILITY NUMBER: 331880740
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/12/2023

Type B

Section Cited

HSC

1569.625(c)(6)

(c) The training shall include, but not be limited to, all of the following: (6) Building and fire safety and the appropriate response to emergencies. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.
	POC Due Date: 10/19/2023
	Plan of Correction
1 2 3 4	Licensee to conduct training and maintain trainng records by POC due date.

Type B

Section Cited

HSC

1569.625(c)(7)

(c) The training shall include, but not be limited to, all of the following: (7) Dementia care, including the use and misuse of antipsychotics, the interaction of drugs commonly used by the elderly, and the adverse effects of psychotropic drugs for use in controlling the behavior of persons with dementia. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.
	POC Due Date: 10/19/2023
	Plan of Correction
1 2 3 4	Licensee to conduct training and maintain training records by POC due date.

SUPERVISOR'S NAME: Nedra Brown TELEPHONE: (951) 202-5776 LICENSING EVALUATOR NAME: Amy Goldenberg TELEPHONE: (951) 201-3990 LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023

Document Has Been Signed on 10/12/2023 02:20 PM - It Cannot Be Edited

FACILITY NAME: GRACIOUS CARE HOME	FACILITY NUMBER: 331880740
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/12/2023

Type B

Section Cited

HSC

1569.625(c)(8)

(c) The training shall include, but not be limited to, all of the following: (8) The special needs of persons with Alzheimer’s disease and dementia, including nonpharmacologic, person-centered approaches to dementia care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.
	POC Due Date: 10/19/2023
	Plan of Correction
1 2 3 4	Licensee to conduct training and maintain training records by POC due date.

Type B

Section Cited

HSC

1569.625(c)(9)

(c) The training shall include, but not be limited to, all of the following: (9) Cultural competency and sensitivity in issues relating to the underserved, aging, lesbian, gay, bisexual, and transgender community. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.
	POC Due Date: 10/19/2023
	Plan of Correction
1 2 3 4	Licensee to conduct training and maintain training record by POC due date.

SUPERVISOR'S NAME: Nedra Brown TELEPHONE: (951) 202-5776 LICENSING EVALUATOR NAME: Amy Goldenberg TELEPHONE: (951) 201-3990 LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023

Document Has Been Signed on 10/12/2023 02:20 PM - It Cannot Be Edited

FACILITY NAME: GRACIOUS CARE HOME	FACILITY NUMBER: 331880740
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/12/2023

Type B

Section Cited

CCR

87411(c)(1)

(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.
	POC Due Date: 10/23/2023
	Plan of Correction
1 2 3 4	Licensee to have employees trained in CPR and first aid and maintain training record by POC due date

Type B

Section Cited

CCR

87411(c)(6)

(6) The licensee shall maintain documentation pertaining to staff training in the personnel records, as specified in Section 87412(c)(2). For on-the-job training, documentation shall consist of a statement or notation, made by the trainer, of the content covered in the training. Each item of documentation shall include a notation that indicates which of the criteria of Section 87411(c)(3) is met by the trainer. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.
	POC Due Date: 10/19/2023
	Plan of Correction
1 2 3 4	Licensee to conduct training and maintain training records by POC due date.

SUPERVISOR'S NAME: Nedra Brown TELEPHONE: (951) 202-5776 LICENSING EVALUATOR NAME: Amy Goldenberg TELEPHONE: (951) 201-3990 LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023

Document Has Been Signed on 10/12/2023 02:20 PM - It Cannot Be Edited

FACILITY NAME: GRACIOUS CARE HOME	FACILITY NUMBER: 331880740
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/12/2023

Type B

Section Cited

HSC

1569.696(a)(1)

(a) All residential care facilities for the elderly shall provide training to direct care staff on postural supports, restricted conditions or health services, and hospice care as a component of the training requirements specified in Section 1569.625. The training shall include all of the following: (1) Four hours of training on the care, supervision, and special needs of those residents, prior to providing direct care to residents. The facility may utilize various methods of instruction, including, but not limited to, preceptorship, mentoring, and other forms of observation and demonstration. The orientation time shall be exclusive of any administrative instruction. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.
	POC Due Date: 10/19/2023
	Plan of Correction
1 2 3 4	Licensee to conduct traiing and retain training record by POC due date.

Type B

Section Cited

HSC

1569.696(a)(2)

(a) All residential care facilities for the elderly shall provide training to direct care staff on postural supports, restricted conditions or health services, and hospice care as a component of the training requirements specified in Section 1569.625. The training shall include all of the following: (2) Four hours of training thereafter of in-service training per year on the subject of serving those residents. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review there are no training records available to verify that the requirement is met. This poses a health, safety or personal rights risk to persons in care.
	POC Due Date: 10/19/2023
	Plan of Correction
1 2 3 4	Licensee to conduct training and maintain training record by POC due date.

SUPERVISOR'S NAME: Nedra Brown TELEPHONE: (951) 202-5776 LICENSING EVALUATOR NAME: Amy Goldenberg TELEPHONE: (951) 201-3990 LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023

FACILITY NAME: GRACIOUS CARE HOME	FACILITY NUMBER: 331880740
	VISIT DATE: 10/12/2023