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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426107
Report Date: 04/09/2024
Date Signed: 04/09/2024 02:21:23 PM

Document Has Been Signed on 04/09/2024 02:21 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:GRACE ADULT DAY CAREFACILITY NUMBER:
336426107
ADMINISTRATOR/
DIRECTOR:		ANWULI, NKECHIFACILITY TYPE:
775
ADDRESS:24318 HEMLOCK AVENUE #F-1TELEPHONE:
(951) 565-0663
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY: 30CENSUS: 25DATE:
04/09/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Licensee, Nkechi AnwuliTIME VISIT/
INSPECTION COMPLETED:
02:25 PM
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On 4/9/2024, Community Care Licensing (CCLD) held an office meeting conducted in the Riverside Adult and Senior Care Regional Office. In attendance was Regional Manager (RM) Reyna Lacey, Licensing Program Manager (LPM) Rikesha Stamps, Licensing Program Analyst (LPA) Janira Arreola, Department of Industrial Relations (DIR) representatives Jocelyn Lopez, Belinda Torres and Licensee Nkechi Anwuli were also in attendance.

The purpose of the meeting was to ensure the facility is in compliance with applicable statutes and regulations. During today’s meeting it was discussed how the licensee plans to comply with DIR regarding a judgment issued in 2016. The licensee provided some documentation today and also agreed to submit additional documents to DIR and provide a response by 4/23/2024 Close of Business. CCL will follow up with DIR to determine compliance.

An exit interview was conducted with Licensee Nkechi Anwuli, who was provided a copy of this report.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/09/2024
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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