Evening Grace Residential Facility for Elderly

Type of visit: Required - 1 Year

On 04/01/25, at 09:45am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, annual visit. Upon arrival, LPA met with Caregiver, Maria Agustin and disclosed the purpose of the visit. The Licensee was called and arrived fifteen (15) minutes later. LPA asked for the census, resident, and staff files. The facility tour started 11:05am Temperature of facility wall thermostat is observed and set to be 70 and 70 degree Fahrenheit. There are two (2) thermostats. One (1) in each hallway. Medications-The medication is kept in two (2) areas. One (1) area is in one (1) of the cabinets in the kitchen area, secured and inaccessible to residents and the rest of the medication is kept in another closet area in one (1) of the staff rooms also inaccessible to residents. The first aid kits is stored in the medication closet in the staff room locked. There is a backyard which has outdoor furniture for outdoor activities available for six (6) residents. There is a pool that is fenced and locked inaccessible to the residents. Living and dining room furniture is accessible for six (6) residents. There is a television, another telephone line and enough seating for six (6) residents. Furniture was observed to be in good condition and there is a fireplace with a covering, inaccessible to the residents. There is one (1) carbon monoxide detector against the wall. The smoke detectors are hardwired and interconnected and were tested. They were functional. LIC 809C-continued Kitchen area was sufficiently stocked with two (2) days of perishable and seven (7) days of non-perishable food. There are three (3) refrigerators in the kitchen area. The cabinets have canned goods. Sharps are kept secured and locked in one of the cabinets under the kitchen sink inaccessible to residents. There is one (1) fire extinguisher located against the wall in the kitchen area fully charged and expires October 2025. The washer and dryer, toxins, and extra hygiene are located in one (1) of the cabinets in the kitchen area inaccessible to the residents locked and secured. There is one (1) phone line located in the kitchen area. The other phone line is located in the living room on top of one (1) of the desks. Bedrooms: There are eight (8) bedrooms with two (2) separate hallways. There are six (6) resident bedrooms and two (2) staff bedrooms. Three (3) of the resident rooms have their private bathroom and are single occupied. The other two (2) bedrooms are also single occupied and have access to one (1) of the private bathrooms. All six (6) bedrooms are properly furnished with proper lightning. The bathrooms have proper toiletry and grab bars. The bathroom temperature of the water are within regulations. They between 114-116 degree Fahrenheit. In between the rooms there is a pantry that has extra linen. The garage is attached to the house and has extra hygiene and incontinence for the residents. There is an entrance leading from one (1) of the staff rooms to the garage area. There is also seating in the front entrance of the facility for staff and residents. Administrative: The Insurance plan is updated, disaster plan, YES sign, evacuation plan sketch and administration certificates are against the wall at the entrance of the facility. On your right hand side of the entrance of the facility, there is a pantry that is locked and inaccessible to the residents that contains extra toxins at the entrance of the facility on your right hand side. The Ombudsman sign is located in the kitchen against the wall. The infection control is in a binder. The fire drill was recently conducted on 03-20-2025 and is also in a binder. The facility has a signal system. An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to the administrator.the state’s words, verbatim · CDSS document, Apr 1, 2025

Type of visit: Required - 1 Year

On 05/14/24, at 11:05 a.m., Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, annual visit. Upon arrival, LPA met with administrator- Mona Dubria and disclosed the purpose of the visit. LPA asked for the census, resident, and staff rosters. The facility tour started 11:50 a.m. Temperature of facility wall thermostat is observed and set to be 74 and 73 degree Fahrenheit. There are two (2) thermostats. Medications-The medication is kept in two (2) areas. One (1) area is in one (1) of the cabinets in the kitchen area, secured and inaccessible to residents and the rest of the medication is kept in another closet area in one (1) of the staff rooms also inaccessible to residents. There first aid kits is stored in the medication closet in the staff room locked. There is a backyard which has outdoor furniture for outdoor activities available for six (6) residents. There is a pool that is fenced and locked inaccessible to the residents. The garage is attached to the house and has extra hygiene and incontinence for the residents. There is an entrance leading from one (1) of the staff rooms to the garage area. There is also seating in the front entrance of the facility for staff and residents. Living and dining room furniture is accessible for six (6) residents. There is a television, another telephone line and enough seating for six (6) residents. Furniture was observed to be in good condition and there is a fireplace with a covering, inaccessible to the residents. There is one carbon monoxide detector against the wall. The smoke detectors are hardwired and interconnected and were tested. They were functional. LIC 809C-continued Kitchen area was sufficiently stocked with two (2) days of perishable and seven (7) days of non-perishable food. There are three (3) refrigerators in the kitchen area. The cabinets have canned goods. Sharps are kept secured and locked in one of the cabinets under the kitchen sink inaccessible to residents. There is one (1) fire extinguisher located against the wall in the kitchen area fully charged and dated May 2025. The washer and dryer, toxins, extra hygiene and napkins are located in one (1) of the cabinets in the kitchen area inaccessible to the residents locked and secured. There is one (1) phone line located in the kitchen area. Bedrooms: There are eight (8) bedrooms. There are six (6) resident bedrooms and two (2) staff bedrooms. Three (3) of the resident rooms have their private bathroom and are single occupied. The other two (2) bedrooms are also single occupied and have access to one (1) of the private bathrooms. All six (6) bedrooms are properly furnished with proper lightning. The bathrooms have proper toiletry and grab bars. The bathroom temperature of the water are within regulations. They between 116-118 degree Fahrenheit. In between the rooms there is a pantry that has extra linen. Administrative: There is no annual fee that is due right now. The Insurance plan is updated, disaster plan, YES sign, evacuation plan sketch and administration certificates are against the wall at the entrance of the facility. On your right hand side of the entrance of the facility, there is a pantry that is locked and inaccessible to the residents that contains extra toxins at the entrance of the facility on your right hand side. The Ombudsman sign is located in the kitchen against the wall. The infection control is in a binder. The facility has a signal system. An exit interview was conducted, no citations were issued, and a copy of this report was given to the administrator.the state’s words, verbatim · CDSS document, May 14, 2024

Type of visit: Required - 1 Year

On 01/08/24, at 11:15 a.m., Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, annual visit. Upon arrival, LPA met with caregiver Conrado Cacacho and disclosed the purpose of the visit. The administrator- Mona Dubria was called and arrived about fifteen (15) minutes later. LPA asked for the census, resident, and staff rosters. The facility tour started 12:45 p.m. Temperature of facility wall thermostat is observed and set to be 75 and 73 degree Fahrenheit. There are two thermostats. Medications-LPA observed two medication rooms stored in one of the cabinets locked and secured in the kitchen area inaccessible to residents and in another closet area in one of the staff rooms also inaccessible to residents. There first aid kits is stored in the medication closet in the staff room. There is a backyard which has outdoor furniture for outdoor activities. There is a pool that is fenced and locked inaccessible to the residents. The garage is attached to the house and was observed to be locked. There is an entrance leading from one of the staff rooms to the garage area. Living and dining room furniture is accessible for six (6) residents. There is a television, another telephone line and enough seating for six (6) residents. Furniture was observed to be in good condition and there is a fireplace with a covering, inaccessible to the residents. There is one carbon monoxide detector against the wall. The smoke detectors are hardwired and interconnected and were tested. They were functional. LIC 809C-continued Kitchen area was sufficiently stocked with seven (7) days of perishable and seven (7) days of non-perishable food. There are three refrigerators in the kitchen area. The cabinets have canned goods. Sharps are kept secured and locked in one of the cabinets under the kitchen sink inaccessible to residents. There is one fire extinguisher located against the wall in the kitchen area fully charged and dated January 2023. The washer, dryer, toxins, extra hygiene and napkins are located in one of the cabinets in the kitchen area inaccessible to the residents locked and secured. The kitchen area has extra water bottles. There is one phone line located in the kitchen area. Bedrooms: There are eight (8) bedrooms. There are six (6) resident bedrooms and two (2) staff bedrooms. Four (4) of the resident rooms have their private bathroom and are single occupied. The other two bedrooms are also single occupied and have access to one of the private bathrooms. All six (6) bedrooms are properly furnished with proper lightning. The bathrooms have proper toiletry and grab bars. The bathroom temperature of the water are within regulations. They between 116-118 degree Fahrenheit. In between the rooms there is a pantry that has extra linen. Administrative: There is no annual fee that is due right now. The Insurance plan is updated, disaster plan, YES sign, evacuation plan sketch and administration certificates are against the wall at the entrance of the facility. On your right hand side of the entrance of the facility, there is a pantry that is locked and inaccessible to the residents that contains extra toxins. The infection control is in a binder. The facility has a signal system. An exit interview was conducted, no citations were issued, and a copy of this report was given to the administrator.the state’s words, verbatim · CDSS document, Jan 8, 2024