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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
486800152
Report Date:
09/09/2024
Date Signed:
09/09/2024 11:37:41 AM
COMPREHENSIVE INSPECTION
Document Has Been Signed on
09/09/2024 11:37 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA
,
CA
95405
FACILITY NAME:
GRACE CARE HOMES
FACILITY NUMBER:
486800152
ADMINISTRATOR/
DIRECTOR:
PATTON, ALEXIS W.
FACILITY TYPE:
735
ADDRESS:
362 WINCHESTER STREET
TELEPHONE:
(707) 246-6826
CITY:
VALLEJO
STATE:
CA
ZIP CODE:
94590
CAPACITY:
6
CENSUS:
4
DATE:
09/09/2024
TYPE OF VISIT:
Case Management - Annual Continuation
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
09:55 AM
MET WITH:
Alexis Patton, Administrator
TIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to complete the Annual Inspection which was started on 08/16/2024. LPA was allowed entrance by care staff. There were 2 staff and 3 residents at the facility at the time of inspection. 1 resident was attending Day Program.
LPA inspected the facility and found it to be clean and orderly. LPA checked on bathroom renovations and found them to be complete and satisfactory. Bathroom is located in bedroom #3.
LPA reviewed 3 of 5 resident files and found several forms were not included. . Administrator will contact Regional Center for missing forms. 5 of 5 staff files were complete.
No citations issued.
SUPERVISORS NAME
:
Kimberley Mota
LICENSING EVALUATOR NAME
:
Jill Nakagawa
LICENSING EVALUATOR SIGNATURE
:
DATE:
09/09/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/09/2024
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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