House of Grace for Senior Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA identified himself and discussed the purpose of the visit with Administrator Helenita Penola. According to the facility’s license, the facility has a maximum capacity of six (6) residents, of whom six (6) can be non-ambulatory. Zero (0) may be bedridden and a hospice waiver approved for two (2) residents. During today’s inspection there were six (6) residents present. LPA, accompanied by Administrator toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water on the premises. Per Administrator, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. [CONTINUED ON LIC 809-C] LPA interviewed staff, resident and reviewed multiple staff and resident records/files. LPA interviews did not raise any licensing concerns. The files which LPA reviewed contained required documents. Confidential records were stored in locked areas. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Helenita Penola to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Oct 31, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Renita Hall, conducted an unannounced Required 1 – Year Visit. The facility file was reviewed prior to the visit. LPA met with Helenita Penola, Administrator and we discussed the purpose of the visit. All staff present have a current criminal record clearance. LPA conducted a tour of the facility, both inside and outside. In accordance with the Department’s Infection Control, LPA evaluated and observed the facility's implementation of their mitigation plan to include disinfection, testing surveillance, and screening protocols as well as the use of personal protective equipment. No deficiencies were cited or observed on this date. Reminder of wearing of face mask. An exit interview was conducted. The Licensee was provided a copy of their appeal rights (LIC9058 03/22), along with a copy of this report.the state’s words, verbatim · CDSS document, Oct 17, 2022

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Kennedy made a visit to the facility as a follow-up to a visit on 9-30-21. During today's visit LPA toured the facility and observed the water temperature was within the required range; ; applicant ordered a first aid manual that meets requirements; non-discrimination policy has been posted; and debris has been removed form the yard. The applicant has been in contact with the insuring agency to obtain the required liability insurance. The applicant shall contact the Centralized Application Unit (CAU) for completion of this pending facility application. An exit interview was conducted with Henelita Penola, Applicant. A copy of this report along with Licensee Rights (LIC9058 01/2016) was provided to Ms. Penola via email. An electronic response confirms the documents were received.the state’s words, verbatim · CDSS document, Oct 15, 2021

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Kennedy conducted a Prelicensing/Component III visit to observe the physical plant for compliance. The LPA was met and granted entry into the facility by Helinita Penola, applicant. The LPA and Ms. Penola toured the physical plant and observed by the LPA were resident accommodations including furnishings, linens and personal hygiene items; resident bathrooms are equipped with non-skid flooring and paper towels, resident, staff and administrative records are to be located the locked medication closet;; food service including dishes, utensils, food storage and a seven day supply of nonperishables and a two day supply of fresh perishables are present; toxic substances are stored locked in a cabinet in the kitchen; medication storage and administration logs are located in locked closet first aid kit is locked in the medication closet; activities, supplies and sufficient space to conduct are present; smoke and carbon monoxide detectors are present and operable; facility posting are present in a common area and the facility administrator's certification is current; no pool or other body of water is present at the facility; per Ms. Penola, there are no guns, weapons or ammunition located on the property. Discussed with Ms. Penola were continuing operation requirements, record keeping and physical plant compliance. The following requirements need to be met prior to licensure: Water temperature needs to be within the required range; liability insurance needs to be acquired; a first aid manual needs to be acquired that meets requirements; non-discrimination policy needs to be posted; debris needs to be removed form the yard. Applicant will provide documentation of meeting these requirements to the LPA. An exit interview was conducted with Helinita Penola, Applicant. A copy of this report along with Licensee Rights (LIC9058 01/2016) was provided to Ms. Penola via email. An electronic response confirms the documents were received.the state’s words, verbatim · CDSS document, Sep 30, 2021