House of Grace 4

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced required annual inspection using the Compliance and Regulatory Enforcement (CARE) Tool. LPA was greeted by facility staff. Administrator Michelle Aguirre was contacted via telephone and informed of the purpose of the visit. The facility’s fire clearance is approved for six (6) non-ambulatory residents, ages 60 and over. The facility also maintains a hospice waiver for four (4) residents. At the time of the inspection, five (5) residents were receiving hospice care, which exceeded the facility’s approved hospice waiver capacity. Facility Tour & Observations: Personal Rights postings (LIC 613C and Long-Term Care Ombudsman information), Complaint Poster (PUB 475), and the nondiscrimination notice were observed posted in a common area. Residents had access to personal space, privacy, and adequate storage for personal belongings. No firearms or weapons were present at the facility. Physical Plant: The facility is in a residential neighborhood and consists of a single-story home with three (3) resident bedrooms, one (1) caregiver bedroom, and three (3) bathrooms, including one (1) caregiver bathroom and one (1) private resident bathroom. The facility also consists of a living room, family room/dining room, kitchen/dining area, detached garage, front yard, and backyard. At the time of the inspection, the detached garage was undergoing construction, and water piping was undergoing repairs. LPA did not observe any interruption or concerns regarding the availability of water for residents in care. Resident bedrooms observed contained the required furnishings, including beds, mattresses, linens, dressers, chairs, and adequate lighting. During the walkthrough, LPA observed three (3) beds in Resident Bedroom #3. Facility staff reported that one (1) of the beds was scheduled to be removed on the day of the visit. LPA observed that sharps, cleaning supplies, and other toxic substances were inaccessible to residents. Sharps were stored in a secured kitchen cabinet. (continued on 809C) Cleaning supplies were secured in the laundry room and in a secured cabinet underneath the kitchen sink. Bathrooms were observed to be clean and equipped with required safety features, including grab bars near toilets and bathing areas and non-skid mats. Toilets, sinks, and bathing fixtures were observed to be operational. Hot water temperature was observed outside the required regulatory range of 105°F–120°F. Extra linens and towels were available and stored in the hallway. Smoke and carbon monoxide detectors were tested and found to be operational. Fire extinguishers were observed and available. No bodies of water were present on the premises. Passageways and exits were observed to be clear and unobstructed. The front and backyard areas contained shaded seating areas available for residents’ use. Food Service: Refrigerators and freezers were maintained at appropriate temperatures, with refrigerators observed at or below 40°F and freezers at 0°F. The facility maintained a sufficient supply of at least two (2) days of perishable food and seven (7) days of non-perishable food. Fresh produce, proteins, and dry goods were observed and available for resident use. Health-Related Services & Records: Three (3) resident files (R1–R3) were reviewed. Resident files contained required documentation, including Admission Agreements, signed consents, Physician’s Reports documenting TB results and ambulatory status, and Resident Rights acknowledgments. During record review, LPA observed that the Needs and Services Plans for R1–R3 had not been updated. An advisory note will be provided as a reminder of the requirement to ensure residents’ Needs and Services Plans are reviewed and updated as required. Three (3) residents’ medications and medication records were reviewed. Medications were observed to be centrally stored and secured in a locked medication storage area located in the laundry room. Disaster Preparedness The most recent fire/earthquake drill was conducted in January 2026. LPA reminded facility staff of the requirement to conduct emergency disaster drills at least quarterly and to maintain documentation of the drills. The LIC 610D Emergency Disaster Plan was available for review and was in the process of being updated at the time of the inspection. Emergency supplies, including water, food, flashlights, batteries, and first aid supplies, were observed and available for use in the event of an emergency. Personnel Records & Training Three (3) staff files were reviewed and included criminal record clearances, CPR/First Aid, required training and TB screenings. Administrator Certificate for Michelle Aguirre was found to be current. An exit interview was conducted with Aries Mendoza, Caregiver. During the inspection, deficiencies were observed and cited on the attached LIC 809D/809C in accordance with Title 22, Division 6 regulations. A copy of this report, LIC 809D/809C, and appeal rights will be provided.the state’s words, verbatim · CDSS document, Sep 29, 2026

The state marks this report as 8 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

We haven’t transcribed this report yet. The complete document is on the state’s site.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced annual inspection visit on 12/18/2025 and was greeted by Caregiver Aries Mendoza. LPA Ramirez identified herself and explained the purpose of the visit. The facility is located on a residential street and is a single-story dwelling. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Physical Plant and Environment safety: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be inaccessible to residents. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected three (3) resident rooms. Facility maintains a staff room. All resident bedrooms contained required furniture, linens and lighting. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. LPA Ramirez observed grab bars near toilets and inside shower. LPA Ramirez observed no-slip coating in showers. LPA Ramirez observed seated shower chairs in bathrooms. Food Service: LPA Ramirez observed sufficient supply of nonperishables for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean and within temperatures of 0-degree F (-17.7 degree C), and refrigerators with maximum temperature of 40-degree F. (4 degree C). See 809-C Planned Activities: LPA Ramirez observed board games, magazines, and other activities for residents. Residents Rights-Information: LPA Ramirez observed the following postings in common areas throughout the facility: Complaint Poster (PUB 475), personal rights, and nondiscrimination notice. LPA Ramirez observed facility land line. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. Last documented emergency drills were conducted on 11/01/2025. LPA Ramirez observed facility sketches with exits and emergency exits routes throughout various locations of the facility. LPA Ramirez observed emergency food supply located in pantry. Residents with Special Needs: No large bodies of water were observed LPA Ramirez observed signs posted indicating “No smoking - Oxygen in Use” in various locations of the facility. LPA Ramirez observed several oxygen tanks in resident rooms secured in stands. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. Auditory devices were observed to be in working order. Health Related Services/Incidental Medical Services: The medications are centrally stored in the medication closet and in bubble packs and/or original containers. LPA Ramirez observed Centrally Stored Medication and Destruction Record. The facility provides incidental medical services. Staffing: Administrator Certificate for Michelle Aguirre 08/29/2026. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Personnel Records Training: Staff files are maintained at the facility. LPA Ramirez observed required annual training, CPR and First Aid for three (3) out of the three (3) personnel record reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for three (3) out of the three (3) personnel record reviewed. Infection Control: Staff are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place. SEE 809-C Operational Requirements: The fire clearance is approved for six (6) non ambulatory residents over the age of 59 years old. This facility may retain no more than four (4) hospice residents. There were four (4) residents on hospice during time of inspection. Resident Records/Incident Reports: LPA reviewed resident records for six (6) residents in care. Resident records are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, Resident Rights were observed. No deficiencies were observed during this visit. Exit interview conducted. A copy of this report was provided via email.the state’s words, verbatim · CDSS document, Dec 18, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cynthia Chan conducted an annual inspection on 9/17/24. LPA arrived unannounced and met with Staff, Alvin Arbis. The purpose for the visit was explained. Administrator, Michelle Aguirre, arrived shortly after to assist with the visit. The facility is licensed for 6 non-ambulatory residents, ages 60 and over. There is a hospice waiver for 4 residents. LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tools. The facility consists of 3 resident shared bedrooms, 1 staff room, 2 1/2 bathrooms, living room, dining room, kitchen, laundry area, and detached garage. There are no swimming pool or bodies of water on the premises. The bedrooms have the required furniture, storage space, and sufficient lighting. The spacious backyard has a shaded area for residents. There is an operable carbon monoxide detector and smoke detectors throughout the home. Knives and cleaning supplies are locked. There is sufficient space to accommodate indoor and outdoor activities. Facility has 2 day perishable and at least a week of non-perishable food. There are currently 6 residents residing at the facility. LPA reviewed all the residents files and the required documents are maintained in their files. Medications are centrally stored and inaccessible to residents. There were no discrepancies found for the meds. The personal rights, complaint and ombudsman posters are posted in a prominent area. LPA reviewed 3 staff files. The administrator's (Michelle Aguirre) certificate expired on 8/28/24. Per the Administrator, she is still in the process of completing the courses to renew the certificate. Staff have current CPR & First Aid certificates. LPA provided technical advisories on annual training for staff. Facility has the Emergency Disaster Plan posted. LPA issued a technical advisory on emergency drills in order to satisfy the requirement. A deficiency was issued today. An exit interview was held and a copy of this report and technical advisory notes were given to the staff.the state’s words, verbatim · CDSS document, Sep 17, 2024

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Alberto Lopez made a subsequent announced visit and was greeted by Licensee/Administrator Michelle Aguirre. LPA explained the purpose of the visit. The purpose of the visit is to verify Licensee compliance for the following: 1) Ombudsman poster 2) Labor law poster 3) Water temperature compliance. 4) Grab bar repair. LPA verified that Licensee corrected the following: 1) Ombudsman poster witnessed by LPA during visit. 3) Water temperature compliance. Verified that water temperature range measured between 108.0 and 116.2 degrees F which is within range of 105.0 - 120 degrees F. 4) Grab bar repair. LPA verified repair of grab bar. The Labor law poster (2) was not posted at facility and Licensee stated that it is not required. LPA is referring the application back to CAB to make the decision if labor law poster is required and approve Licensee.the state’s words, verbatim · CDSS document, Nov 17, 2023

The state marks this report as 5 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.