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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603828
Report Date: 01/11/2024
Date Signed: 01/11/2024 12:00:47 PM


Document Has Been Signed on 01/11/2024 12:00 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:A PLACE OF GRACE INC CHASE AVENUEFACILITY NUMBER:
374603828
ADMINISTRATOR:SHANTA HAINESFACILITY TYPE:
735
ADDRESS:1144 E CHASE AVETELEPHONE:
(619) 631-7656
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY:4CENSUS: 3DATE:
01/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Manuel Marquez, DSP
Justin Felan, Director		TIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Renita Hall, conducted an unannounced Required 1 year Annual Visit. LPA was allowed entry by Manuel Marquez, DSP. LPA identified herself and disclosed the purpose of the visit with Manuel Marquez, DSP, and was later joined by Justin Felan, Director.

Physical Environment:  The facility was found to be clean, well-maintained, and free from any safety hazards. Adequate lighting and ventilation were observed in all areas of the facility. All necessary safety equipment, such as fire extinguishers and emergency exits, were present and in good working condition. The facility's outdoor spaces were properly maintained and accessible to residents.

Staffing and Training:  The facility had a sufficient number of qualified staff members to meet the needs of the residents.  The staff members were observed to be professional, courteous, and knowledgeable in their respective roles.  All staff members had completed the required training and certifications per the licensing regulations.  Staffing schedules were posted and adhered to, ensuring adequate coverage at all times.

Resident Care and Services:  Residents' care plans were reviewed and found to be comprehensive and up-to-date.  Medication administration was observed to be in accordance with the facility's policies and procedures. Residents' nutritional needs were met. Recreational activities and social engagement opportunities were available to residents regularly.
Continued on 809C
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita HallTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: A PLACE OF GRACE INC CHASE AVENUE
FACILITY NUMBER: 374603828
VISIT DATE: 01/11/2024
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Health and Safety:  Regular health assessments and monitoring of residents' well-being were conducted by qualified healthcare professionals.  Infection control measures were in place and followed by staff members. The facility had established protocols for emergencies and evacuation plans were readily available.

Overall, the facility was found to comply with the licensing regulations.  An exit interview was conducted and a copy of this report along with the Licensee Rights (LIC 9058) was provided to Justin Felan, Director. His signature on this form confirms receipt of the documents.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita HallTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC809 (FAS) - (06/04)
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