Graceful Living Adult Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. made an unannounced visit for the purpose of conducting the required annual inspection. LPA was greeted and granted entry by Administrator (AD) Donia Anaim. LPA observed that AD Donia Anaim has a valid AD certificate which expires on October 7, 2026. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, with a hospice waiver for six. The facility is a single story home with five private resident bedrooms, two shared resident bathrooms, one staff bedroom, a living room, a family room, a kitchen, a dining room, and an detached two car garage. LPA and AD tour the interior and exterior of the facility. On today's visit, LPA observed three residents in care, one of which is on hospice. LPA observed residents relaxing in their respective bedrooms. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall in the entryway of the facility. LPA toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. LPA observed resident linens and blankets to be clean. LPA observed additional linens stored in a closet in the resident hallway. LPA observed Oxygen in Use signs posted in the appropriate resident doorways. LPA observed that the staff room is kept locked and inaccessible to residents in care. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Hot water temperature measured between 113.3 and 116.1 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. CONTINUED ON LIC809-C Sharp items and knives were locked and inaccessible to residents in care. Fire extinguishers was charged and located by the living room. LPA observed the emergency disaster and evacuation plan which is located by the entrance. Facility had back-up emergency food and water supply. LPA observed that the First Aid Kit had all the required components. LPA observed that medications and toxins were locked and inaccessible to residents in care. Medications are locked in a cabinet in the kitchen. For the exterior portion, LPA observed a shaded area, patio furniture, and the grounds were free of any hazards. There are two gates in the backyard. LPA did not observed a body of water. LPA reviewed three resident files and two staff files. LPA interviewed residents and staff present. For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations. LPA advised AD to use the general email address: CCLASCPOrangeCountyRO@dss.ca.gov for any inquiries and to specify attention to the assigned LPA. An exit interview was conducted with AD Anaim. A copy of this report was provided at the time of exit.the state’s words, verbatim · CDSS document, Jan 21, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit for the purpose of conducting the required annual inspection. LPA was greeted and granted entry by caregiver staff after explaining the purpose for the visit. Administrator Donia Anaim was notified via telephone and later arrived to assist with the inspection. LPA observed that Administrator Donia Anaim has a valid Administrator certificate which expires on October 7, 2026. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, with a hospice waiver for six. The facility is a single story home with five private resident bedrooms, two shared resident bathrooms, one staff room, a living room, a family room, a kitchen, a dining room, an unattached two car garage, and a shed located in the backyard. LPA accompanied by the AD conducted a tour of the interior portion of the facility. On today's visit, LPA observed five residents in care, five of which are on hospice, and two caregiver staff present. LPA observed residents relaxing in their respective bedrooms and in the family room. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall in the entryway of the facility. LPA inspected all five resident bedrooms and they were observed to be free of hazards. LPA observed the resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident linens and blankets to be clean. LPA observed additional linens stored in a closet in the resident hallway. LPA observed Oxygen in Use signs posted in the appropriate resident doorways. LPA observed that the staff room is kept locked and inaccessible to residents in care. LPA inspected the two shared resident bathrooms. Resident bathrooms are clean. Bathrooms are equipped with grab bars and non-skid floors. Faucets and toilets were operational. Hot water temperature measured between 117.5 and 117.6 degrees Fahrenheit. LPA observed the kitchen has a two day perishable and seven day non-perishable food supply on hand. LPA observed kitchen appliances to be clean and operational. CONTINUED ON LIC809-C The four burner gas stove lights unassisted. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed chemicals and toxins to be stored in a locked kitchen cabinet under the sink. A fire extinguisher is located in the family room and it was observed to be charged and serviced as of December 12, 2024. LPA tested the wired smoke detectors/carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on December 5, 2024. The centrally stored medication is stored in a locked cabinet in the kitchen. LPA observed a First Aid Kit to be stored in the locked kitchen cabinet. LPA inspected the First Aid Kit and observed it to have all the required components. LPA accompanied by the AD toured the exterior portion of the facility. LPA observed the exterior portion to be free of obstructions and hazards. LPA observed an shaded outdoor seating area with furniture for resident use. The door leading to the unattached two car garage is kept locked and inaccessible to residents in care. LPA observed the facility has a three day emergency food and water supply stored in the two car garage. LPA inspected the shed located in the backyard. LPA observed the shed to be locked and inaccessible to residents in care. LPA observed the shed to be used for storage. The two perimeter gate on the north side of the facility are self-latching and can be opened in an evacuation. There are no bodies of water located on the premises. LPA reviewed all five resident files. LPA observed that Resident #1, Resident #2, Resident #3, and Resident #4 had Reappraisals that were outdated. LPA also observed that Resident #1, Resident #2, Resident #3, and Resident #4 did not have a valid Admission Agreement on file. LPA reviewed all five residents' medication and medication records. LPA reviewed two staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, deficiencies are being cited per the Title 22 of the California Code of Regulations. An exit interview was conducted with Administrator Donia Anaim. A copy of the report and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Jan 29, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Sean Haddad conducted this announced inspection for the purpose of conducting a pre-licensing inspection. LPA met with Applicant (AP) Donia J. Anaim, discussed the purpose of the inspection, and toured the facility. Facility is to operate a Residential Care Facility for the Elderly. Application was submitted to Community Care Licensing on 10/27/2023. This is a change of ownership with persons in care. During the inspection, LPA and AP observed the following: Structure: facility is a 5-bedroom, 2-bathroom, 1-story house with a detached garage that is used for storage. Facility telephone number is (714) 538-8476. Resident Bedrooms: the 4 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Lights, chairs, linens, and storage for each resident bedroom inspected. Staff Bedrooms: the 1 staff bedroom is spacious and will easily accommodate the staff’s furnishings. Bathrooms: were clean, faucets and toilets were operational. Water temperature: tested at 112 degrees F in the common resident bathroom and 113 in the private resident bathroom. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: 2 days perishable and 7 days nonperishable food supply reviewed. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the kitchen and garage. Medication cabinet is locked. First-Aid Kit & Activity Supplies: observed and available. Resident & Staff Files: LPA reviewed 5 resident files and 2 staff files. Per AP, Fire clearance was approved by the Orange Fire Department. Backyard exit gate is operational and unlocked. Backyard has shaded area for outdoor activities and sufficient seating for residents. Component III was completed with AP during today’s inspection. Facility is currently operating under the liability insurance of current facility GOLDEN LEISURE HOME I (306003669). AP will switch liability insurance to new facility once the application is approved. During the inspection, LPA explained the process of this application and about the post licensing inspection once the facility is licensed. AP was informed today that the facility is ready for licensure pending receipt of a granted fire clearance and final approval will be processed by the CAB supervisor in Sacramento. An exit interview was conducted and a copy of this report was discussed with and provided to AP.the state’s words, verbatim · CDSS document, Jan 9, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 6 COMP II Participants: Donia Anaim, Applicant and Marica Garcia, Administrator Interview Method: Virtual interview (MS Teams) On 01/05/2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jan 5, 2024