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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366425135
Report Date: 03/11/2021
Date Signed: 03/11/2021 01:40:13 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:GRACIOUS LIVINGFACILITY NUMBER:
366425135
ADMINISTRATOR:DAVID KRAUSEFACILITY TYPE:
740
ADDRESS:1592 N. EUCLID AVETELEPHONE:
(909) 982-1650
CITY:UPLANDSTATE: CAZIP CODE:
91786
CAPACITY:6CENSUS: 0DATE:
03/11/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Paul KrauseTIME COMPLETED:
12:07 PM
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Licensing Program Analyst (LPA) Natalie Gayoso contacted the facility via telephone to commence a case management visit due to COVID-19. LPA identified herself and discussed the purpose of the call with administrator Paul Krause.

The purpose of today's visit is to follow up on the facility's closure. LPA was informed by the administrator that a relocation application was submitted back in August 2020 to relocate to a new address due to owner taking back property.
All residents were relocated to the new licensed location (439 E Kenwood St, Upland) as of 10/15/2020. LPA was unable to tour property due to the house is occupied and individuals live there. LPA was able to verify that the residents were relocated to the new facility address. LPA requested for the licensee to surrender the license and mail it to the Regional Office.

The facility is closed as of today's date 3/11/21.

An exit interview was conducted with the administrator via telephone and a copy of this report was provided via email.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Natalie GayosoTELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2021
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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