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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426107
Report Date: 04/02/2025
Date Signed: 04/03/2025 04:10:41 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/08/2024 and conducted by Evaluator Debbie Palacios
COMPLAINT CONTROL NUMBER: 18-AS-20241108135349
FACILITY NAME:GRACE ADULT DAY CAREFACILITY NUMBER:
336426107
ADMINISTRATOR:ANWULI, NKECHIFACILITY TYPE:
775
ADDRESS:24318 HEMLOCK AVENUE #F-1TELEPHONE:
(951) 565-0663
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY:30CENSUS: 26DATE:
04/02/2025
UNANNOUNCEDTIME BEGAN:
10:33 AM
MET WITH:Nkechi Anwuli-Director/AdministratorTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff neglect resulting in client injury.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Debbie Palacios arrived unannounced to the facility to conclude an investigation into the allegation listed above. LPA met with Administrator Nkechi Anwuli and explained the purpose of the visit. During the investigation, LPA conducted interviews with staff and conducted a review of pertinent information.
On November 9, 2024, Community Care Licensing received a complaint alleging staff neglected resulting in client injury. It was reported that Staff #1 (S1) was in a car accident while transporting seven clients. It was reported that S(1) fell asleep while driving. It was reported that S(1) was traveling at 65 miles per hour to the facility. Due to the accident, clients were taken to the hospital and evaluated for injuries. Medical documentation reported that Client #1 required stitches due to a cut on their forehead. No other injuries were reported. Information obtained from interview with Administrator stated that the incident was reported to all required agencies. Administrator stated that S1 did fall asleep while transporting clients. Administrator admitted that Client #1 sustained a cut to their forehead and required stitches. Administrator indicated that S1 resigned immediately after the incident.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 18-AS-20241108135349
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: GRACE ADULT DAY CARE
FACILITY NUMBER: 336426107
VISIT DATE: 04/02/2025
NARRATIVE
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LPA interviewed Staff #1 (S1) and denied that they fell asleep while driving. Staff #1 stated that they believed they fainted and woke up to the motion and sounds of the airbags being deployed. It was advised that S1 is no longer employed at the facility. LPA attempted to interview Client #1, but LPA was unable to obtain contact. LPA obtained a copy of police report created by Riverside County Sheriff dated September 20. 2024. A review of the report advised that S1 was transporting 7 clients and S1 admitted that they fell asleep causing a three car accident. The report documented that S1 was at fault. The police report did not indicate that Client #1 was injured in the incident. Additional pertinent information corroborated the information regarding Client #1’s injury.
Based on LPA’s observations, interviews conducted, and records reviewed, the preponderance of evidence standard has been met. Therefore, the allegations that staff neglect resulted in Client #1’s injury is found to be substantiated. The facility will be cited pertaining to California Code of of Regulations. This violation poses a health and safety risk to clients in care.

An exit interview was conducted. A copy of this report, LIC 9099-D, the LIC 811 and appeal rights were provided to Administrator Nkechi Anwuli .
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20241108135349
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: GRACE ADULT DAY CARE
FACILITY NUMBER: 336426107
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/02/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/02/2025
Section Cited
CCR
82072(a)(2)
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82072 (a)(2) Each client shall have personal rights which include accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
This requirement is not met as evidenced by:
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Licensee will provide staff Personal Rights and safety risk training by the POC due date on 05/02/2025.
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Based on observation and interview, the staff did not comply with the section cited above in ensuring the safety of the clients, which posed an immediate health, safety, or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3