Aging Grace Senior Living Facility

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a required comprehensive annual inspection. LPA met with Jessica Berumen, caregiver, were granted entry to the facility, and discussed the purpose for the visit. Administrator, Brittany Martin, arrived shortly after to the facility. The facility is a Residential Care Facility for Elderly (RCFE) with a license capacity of (6), and a current census of (6). LPA conducted a general inspection of facility, which included, but was not limited to, the following: Operation/Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). Indoor and outdoor passageways were kept free of obstruction. The facility has no swimming pools or similar bodies of water. The facility has sufficient indoor and outdoor space for resident activities. The facility's outdoor activity space is shaded and enclosed with latching gates. Resident bedrooms were furnished with beds, bed linen, night stands, chairs, and sufficient lighting. Resident bathrooms were maintained clean, fixtures were operating properly, and equipped with non-skid mats. The hot water temperatures in the bathrooms measured at 106 degrees F. The facility is equipped with smoke detectors and carbon monoxide alarms, emergency supplies/water, fully charged fire extinguishers, first aid kit with manual, laundry equipment, hallway night light, and telephone service. The facility has posted in a common area Community Care Licensing complaint poster, Ombudsman poster, resident personal rights, activity schedule, sample menu, facility license, and emergency telephone numbers. Sharps and cleaning supplies were kept locked. Food Service: Kitchen and dining areas were maintained clean. Non-perishable and perishable food supply was sufficient for number of residents in care. Cups, plates, and utensils were sufficient for number of residents in care. Care and Supervision: The facility staff schedule reflects 24 hours a day, 7 days a week staff coverage. Staff working have Criminal record clearances with the Department. Health Related Services: Medications are centrally stored in a locked closet. LPA audited medications of four (4) residents. Review of Resident#1 (R1's) medications revealed that R1's did not have a refill of their prescribed over the counter daily medication. R1 had not been administered the medication since March 12, 2026. The Administrator stated that they will have staff pick-up R1's the medication today. File review reveals there was no documented of staff follow-up on the status of resident's medication. LPA also observed that 9 pills of Resident #2 (R2's) prescribed "one daily" medication had been dispensed since being refilled on March 14, 2026. Interviews with both the Administrator and staff reveal, that staff has been dispensing a new pill each time resident refused the medication. No documentation of resident medication refusal was observed. Record Review: Resident files were reviewed for admissions agreements, physician’s reports, appraisals, needs and services plans. Staff files were reviewed had First Aid/CPR certifications, criminal record clearances, job training, health screenings, Administrator certification. The facility maintains facility’s insurance, infection control plan, disaster and emergency plan for review. During today's visit, deficiencies were cited in accordance with Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted where reports (LIC809, LIC809C, LIC809D) were discussed and a copies provided with appeal rights to Caregiver Berumen.the state’s words, verbatim · CDSS document, Mar 20, 2026

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Magda Malcore and Eldin Serrano made an unannounced visit to the facility to conduct a required comprehensive annual inspection. LPAs met with Jessica Berumen, caregiver, were granted entry to the facility, and discussed the purpose for the visit. Administrator, Brittany Martin, arrived shortly after to the facility. The facility is a Residential Care Facility for Elderly (RCFE) with a license capacity of (6), and a current census of (6). LPAs conducted a general inspection of facility, which included, but was not limited to, the following: Operation/Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). Indoor and outdoor passageways were kept free of obstruction. The facility has no swimming pools or similar bodies of water. The facility has sufficient indoor and outdoor space for resident activities. The facility's outdoor activity space is enclosed with a self-latching gate. The facility is maintained at a temperature of 77 degrees F. Resident bedrooms were furnished with beds, bed linen, night stands, chairs, and sufficient lighting. Resident bathrooms were maintained clean, fixtures were operating properly, and equipped with non-skid mats. The hot water temperatures in the bathrooms measured at 116.2 degrees F. The facility is equipped with smoke detectors and carbon monoxide alarms, two (2) fully charged fire extinguishers, laundry equipment, hallway night lights, and telephone service. The facility has posted in a common area Community Care Licensing complaint poster, Ombudsman poster, resident personal rights, activity schedule, menu, facility license, and emergency telephone numbers. Sharps, cleaning supplies, and other chemicals were kept locked and inaccessible to residents in care. The facility staff schedule reflects 24 hours a day, 7 days a week staff coverage. Food Service: Kitchen and dining areas were maintained clean. Non-perishable and perishable food supply was sufficient for number of residents in care. Cups, plates, and utensils were sufficient for number of residents in care. Health Related Services: The facility maintains record of resident’s medications and medications were centrally stored in a locked medication room. The facility maintains a first aid kit with first aid manual. ***continued*** Record Review: Resident files reviewed had admissions agreements, physician’s reports, appraisals, needs and services plans. Staff files reviewed had First Aid/CPR certifications, criminal record clearances, job training, and health screenings. The Administrator’s certification, facility’s insurance, infection control plan, disaster and emergency plan are up-to-date. No deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted where this report (LIC809) was discussed and a copy provided to Administrator Martin, at the conclusion of the visit.the state’s words, verbatim · CDSS document, Mar 19, 2025

Type of visit: Required - 1 Year

On 04/04/24, Licensing Program Analyst (LPA) Michelle Echeverria arrived unannounced to conduct the required annual visit to the facility. LPA met with staff, Casey Kaler and introduced self and stated purpose of the visit. LPA was informed that there are currently 5 residents in care who are having breakfast in the dining room. The facility has 3 resident bedrooms, 2 resident bathrooms, 1 staff bedroom, kitchen, dining area, living room, 2 activity rooms, attached garage, and backyard with a shed. LPA completed a walk through of facility, review of records and medication audit. Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 70 degrees fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA inspected resident bathrooms; bathrooms were clean and appliances were found functional. Water temperatures tested at 105.2 degrees fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarms, fire extinguisher and first aid kit. Posters such as; the personal rights, ombudsman, complaint poster and emergency disaster plans were posted in a common area. LPA also observed cleaning supplies, toxins, sharps, and other dangerous items locked in cabinets made inaccessible to residents. There was a designated storage space for resident/staff files. Medications were observed secured and inaccessible to residents. There are no guns or ammunition in the facility. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a wide variety of food available for residents. Dishes, cups, and utensils were also stored properly. LPA observed a lock placed on the refrigerator unable to be opened without a key. Technical violation issued. Yards/Outside: One shaded patio, a side gate with self-latching handle on the left side of the house that leads into the backyard, and 1 shed used for storage. All outdoor pathways were free of obstructions. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed 5 resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed staff and administrator's file for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. Medications were audited at random and appeared to be predispensed by removing the daily dosage from its original container and placing it in a daily container by staff. Technical violation issued. The facility last conducted a fire drill on 02/20/2024. Two technical violations and no deficiencies were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, LIC9102TV were discussed and copies were provided to the administrator, Brittany Martin who later arrived.the state’s words, verbatim · CDSS document, Apr 4, 2024

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.