<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426107
Report Date: 02/25/2025
Date Signed: 02/25/2025 04:30:25 PM

Document Has Been Signed on 02/25/2025 04:30 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: 22DATE:
02/25/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Licensee- Nkechi AnwuliTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 02/25/25 Licensing Program Analyst (LPA) Debbie Palacios made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Administrator Hillary Ocholla who was informed of the purpose of the visit; Licensee arrived to the facility approx. 30 minutes after. The facility has a fire clearance 30 clients and five (5) non-ambulatory.

LPA toured the facility and reviewed records. During the tour, LPA observed the facility is a one story building center that has a section with tables and chairs for clients to do Arts and Crafts activities, table top games and range of motion exercises, interaction with peers. There is twenty two (22) clients and six (6) staff present in the facility. The facility has 3.5 restrooms, facility has one (1) room where the keep activity games, PPE and first aid kit are kept locked in a cabinet, staff and client files are stored in a separate cabinet. The facility has a kitchen/lunch area for the staff only. Facility does not provide lunch or administrates medications, staff reported that clients bring their own lunch and snacks. The facility has required furniture, lighting, and a locked closet storage for personal hygiene supplies. LPA also observed four (4) charged fire extinguishers mounted throughout the facility, last serviced on 09/18/24. Facility has multiple operating dual smoke alarms and carbon monoxide detector that meet statutory standards. LPA toured the facility's exterior and observed outdoor pathways were free of obstructions; there is three (3) emergency doors. LPA reviewed client files that had the required documents on file. Staff files reviewed had the Department's required training records and valid first aid/CPR certification.

Licensee was notified that CCLD has not received the facility's annual fee for 2025. LPA provided Licensee the PIN number (376317) to pay the annual fee.

No deficiencies were observed during today's visit. An exit interview was conducted and a copy of this report was provided.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 3 of 3