Grace Senior Solutions #2

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct an Annual Required Evaluation. The Annual- Required was not provided for the report drop-down and a hard copy of the Care Tool was utilized during the visit. LPA was greeted and granted entry by Staff at 1pm. LPA met with House Manager, Glenn Navarro and explained the purpose of the visit. The facility is a six bedroom, two bathroom residential home with an approved fire clearance for six non-ambulatory residents, in rooms 1-6, and one bedridden in Room #1 only. The facility is approved for a hospice waiver for six. Currently there are six residents and one additional tenant in bedroom #4 that receives care and three live-in staff members. There are three residents who receive hospice services. During today's visit, LPA toured the facility and the facility was 74 degrees Fahrenheit. LPA tested and inspected carbon monoxide and smoke detectors and both detectors were operational. A fire extinguisher was charged and inspected on August 4, 2026 and is located by the front door. The last fire and earthquake drill was conducted on July 27, 2026. LPA measured two of two bathroom hot water temperatures. The hot water temperatures ranged between 110.5 to 113.1 degrees Fahrenheit. Two of two bathrooms had non skid flooring, covered trash bins and grab bars in showers. LPA observed six resident rooms and all rooms were clean and had the required furnishings. Bedroom #1 is shared with two residents and the remaining bedrooms are single occupancy. Per interview, the tenant in Bedroom #4 receives assistance with showering, medications are centrally stored (Continued on LIC 809-C) (Continued from LIC 809) and given to the resident at the prescribed time. The tenant also is served meals three times a day and is unable to cook their own meals. A family member lives nearby and provides transportation for medical services. Thus, the tenant is being provided care and supervision per Title 22 and the facility is over-capacity with seven residents. Additionally, the facility sketch documents that there is a two car garage but the area has been converted to an Additional Dwelling Unit for three of three staff members. A deficiency will be cited. An immediate $500 Civil Penalty will be assessed for fire clearance. While touring resident bedrooms, LPA observed the resident in bedroom #3 had four half-rails on two sides of the bed. The resident is on hospice and had full bed rail orders. A deficiency will be cited for using four half-bed rails. The staff immediately removed all bed rails. LPA toured the kitchen and observed the facility has two days of perishable items and seven days of non perishable items. Appliances were in working order and emergency supplies were stored in the pantry. LPA observed medication storage and reviewed the centrally stored mediations. Per review medications are being given as prescribed. LPA reviewed three of three staff training and fingerprint records and conducted a complete review of resident records. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on August 14, 2027. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Glenn Navarro, House Manager and a copy of this report was given to the facility along with a copy of the LIC 858, LIC 859; LIC 809-D, LIC 421IM and Appeal Rights.the state’s words, verbatim · CDSS document, Sep 1, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Sep 2, 2026

a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. This requirement was not met as evidenced by: Based on LPA observations and interviews, an additional tenant receives (cont'd) care and supervision and is considered a seventh resident. The facility is approved for six residents and is over capacity by an additional resident. This poses an immediate health and safety risk for persons in care.the state’s words, verbatim · CDSS document, Sep 1, 2026

Plan of correction: Administrator and House Manager will submit a plan of action regarding fire clearance, via email, to the Department by the POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87608(a)(5)(B) · Plan of correction due date: Sep 2, 2026

(a) ... Postural supports may be used under the following conditions. (5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. (B) Bed rails that extend the entire length of the bed are prohibited except for residents (cont'd) who... have a hospice care plan that specifies the need for full bed rails. This requirement was not met as evidenced by. Based on LPA's observations the resident had four half rails. This poses an immediate health and safety risk for one of seven residents in care.the state’s words, verbatim · CDSS document, Sep 1, 2026

Plan of correction: Staff immediately removed the four bed raills during visit.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87305(a) · Plan of correction due date: Sep 2, 2026

Alterations to Existing Building or New Facilities. (a) Prior to construction or alterations, all facilities shall obtain a building permit. This requirement was not met as evidenced by: Based on LPA's observations and interviews, the two car garage was converted into an additional dwelling unit (cont'd) with two staff bedrooms. The approved fire clearance with the Department shows this area is a garage. This poses an immediate health and safety risk for three of three persons residing in the garage.the state’s words, verbatim · CDSS document, Sep 1, 2026

Plan of correction: Administrator and House Manager will submit Plan of Action regarding additional dwelling unit, via email, to the Department by POC due date.

Type of visit: Required - 1 Year

On September 10, 2025, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by staff and granted entry after stating the purpose of the visit. House Manager/ Administrator Glen Navarro was not available to assist with the facility inspection. Staff contacted Administrator to notify of visit. The facility is licensed for six (6) non-ambulatory residents, which one (1) may be bedridden with approved hospice waiver for six (6) residents. Currently, there are four (4) Hospice residents present during today’s visit. This is a single story home with attached garage facility. The facility has six private resident bedrooms, and two full bathrooms At around 12:15PM, LPA conducted a tour of the physical plant accompanied by Caregiver Maria Labos, and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured between 107.9 to 110.6 degrees F. A comfortable temperature of 74 degrees F. was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Storage areas for cleaning supplies and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient two day perishable and seven day non-perishable food was maintained adequately. Facility has supply of emergency food and water. CONTINUED ON 809C Facility has one fire extinguisher was mounted and charged. Backyard has shaded seating area for residents and visitors. A review of the Medication Records Administration (MAR) was conducted, and LPA observed the records are in compliance. During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors. LPA observed the facility has supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on February 17, 2025. The facility had operational smoke and carbon monoxide detectors in bedrooms and common areas. A review of six residents (R1-R6) service files and four staff (S1-S4) personnel files were reviewed. The facility has the current administrator's certification on file for Jennifer Ghahyasi-Brower verified on active pending list # 7018829740. No deficiencies during this inspection visit. A Technical Advisory regarding resident records was issued. An exit interview was conducted with Caregiver Labos, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 10, 2025

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Rose Ruppert made an announced visit to the facility for the purpose of conducting a pre-licensing inspection follow-up from September 6, 2024. LPA met with Manager, Glenn Navarro at 1pm. LPA toured the facility and observed six bedrooms and all have the required furnishings. One bedroom has a full bed, five bedrooms have a twin bed and all beds have mattresses and linens. The hot water temperature was measured in two of two resident bathrooms at 108.4 and 108.6 degrees Fahrenheit. The fireplace in the living area and in the back bedroom both have screens. A First Aid manual book was purchased to accompany the First Aid Kit and a weekly menu was observed on the refrigerator. Manager was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. An exit interview was conducted and a copy of this report was provided to the Manager.the state’s words, verbatim · CDSS document, Sep 10, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Rose Ruppert made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPA met with Licensee (LE) Jennifer Ghahyasi. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by our agency on March 18, 2024 for a total capacity of six; six non ambulatory and one bedridden in room one. The facility is approved for six residents on hospice. The facility is a one story home with six private resident rooms, two bathrooms, a living room, a kitchen, a dining area, and an attached two car garage. There is a backyard exit gate on the side of the house that is self-latching and unlocked. There is a shaded seating area and LPA did not observe any obstacles or hazards in the backyard. LPA observed the See Something, Say Something poster (PUB 475), Personal Rights, and Emergency Disaster Plan, Menu and Administrator's Certificate on kitchen bulletin board.. Two of six resident bedrooms had the required furnishings. LPA observed two beds with linens in rooms five and six. All toxic chemicals, cleaning solutions, and disinfectants are inaccessible to residents and will be stored and locked in secured hall closet with a locked medication cart. The first aid kit is mounted in kitchen and has all the required elements. Reading materials and games were observed in the living room with a phone for resident use. A supply of two-day and seven-day of non-perishable food was observed and will be maintained on hand. Smoke detectors and carbon monoxide detectors tested operational. Gas burner stove, dishwasher, refrigerator, microwave, washer, and dryer are operational. LPA will return on Thursday, September 12, 2024 at 1pm. Licensee will provide a bed in four resident rooms, fireplace screens for two fireplaces and will adjust hot water temperature to be within 105-120 degrees Fahrenheit for both bathrooms. Licensee also purchased a First Aid Manual for the facility. Licensee has waived the Component III since LE currently operates two facilities. Administrator's certificate expires on August 15, 2025. An exit interview was conducted and a copy of this report was provided to Licensee.the state’s words, verbatim · CDSS document, Sep 6, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: GHAHYASI, JENIFER - Applicant/Administrator Interview Method: Telephone interview On 08/21/2024, 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, Aug 21, 2024