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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804128
Report Date: 12/18/2024
Date Signed: 12/18/2024 04:47:05 PM

Document Has Been Signed on 12/18/2024 04:47 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:A PLACE OF GRACE, INC. - MIDWAYFACILITY NUMBER:
486804128
ADMINISTRATOR/
DIRECTOR:
DIAZ, FREDDIEFACILITY TYPE:
737
ADDRESS:4767 MIDWAY RD.TELEPHONE:
(707) 447-7634
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY: 4CENSUS: 2DATE:
12/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:26 PM
MET WITH:Freddie Diaz, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:50 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced at the facility, A Place of Grace, Midway on 12/18/2024 to conduct an inspection with the facility's Administrator, Freddie Diaz. The facility currently has 2 residents. At the time of inspection there were 4 staff members. The facility was decorated for Christmas, with lights and a tree in the living room- very homey and welcoming.

The facility was clean and well-organized and well-appointed with comfortable furnishings for the clients' use. Four bedrooms had required furnishings and there was a supply of linens and hygiene supplies for clients' use. Inspection of clients' rooms found them to be clean and well-organized; free of dust and cobwebs. There are 2 bathrooms that were clean and sanitary. The delayed egress door was operational. The grounds were free of any apparent hazards, fire exits were clear. The back yard has a large patio area; shaded and comfortably furnished. There was also a pickle ball court. Locked cabinets for resident and staff records, as well as medications and first aid kit, observed in the secured office. Sharps for kitchen are also locked in the medication cabinet in the secured office. Kitchen was spacious and clean. Induction stove used for safety. There was an ample supply of perishable and nonperishable foods, appropriately labeled and dated. There are locked cabinets for cleaning/laundry supplies in hall closet. Required postings were observed at the front door and throughout the facility. 2 exterior sheds were locked and used for storage. Third shed contains the well for the property. Staff provide a variety of activities for the residents: outings, walks, shopping, menu-planning and cooking, arts and crafts, card games and watching sports or a movie together or listening to music.

Clients were happy and stated that staff did a good job and they liked the food and the facility.

No deficiencies found at the time of inspection. No citations issued.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2024
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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