Amazing Grace & Care

Type of visit: Required - 1 Year

On December 8, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Licensee Elena Bor was notified via telephone and later arrived to assist with the inspection. LPA observed that Elena Bor has a valid Administrator certificate which expires on June 17, 2027. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for six. The facility is a two story home. Only the first floor of the home is licensed to provide care and supervision and it consist of: five resident bedrooms, one of which is shared, five resident bathrooms, a living room, a dining room, a family room, a kitchen, a laundry area, and a detached two car garage. LPA, accompanied by the LI, conducted a tour of the interior portions of the facility. On today's visit, LPA observed six residents in care and two care giving staff present. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the resident hallway. LPA inspected the five resident bedrooms and observed them to be clear of any hazards. LPA observed resident bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed additional linens to be stored in hallway cabinets. LPA inspected the five resident bathrooms and observed them to be clean. Resident bathrooms were equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 116.6 and 117.1 degrees Fahrenheit. LPA observed the facility has a two day perishable and a seven day non-perishable food supply in the kitchen. CONTINUED ON LIC809-C 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. LPA observed a fire extinguisher to be mounted on the wall in the kitchen and it was observed to be charged and serviced as of July 23, 2025. LPA tested the wired smoke detectors/carbon monoxide detectors which tested operational. LPA observed the facility conducted their most recent emergency disaster drill on October 10, 2025. LPA observed the centrally stored medication to be kept in a locked cabinet in the kitchen. LPA observed there is also a First Aid kit stored in the cabinet which has all the required components. LPA, accompanied by the LI, conducted a tour of the exterior portions of the facility. LPA observed the exterior to be clear of any obstructions or hazards. LPA observed a shaded outdoor seating area with furniture for resident use. LPA observed the door to the detached two car garage to be kept locked and inaccessible to residents in care. LPA observed the garage to be used for storage. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed the perimeter gate to be self-latching and can be opened in an evacuation. There is a pool located in the backyard which is adequately fenced and kept locked for resident safety. LPA reviewed all six resident files. All the required documentation were present and current in the resident files reviewed. LPA reviewed the residents' medication and medication administration records. LPA reviewed five staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, no deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Licensee Elena Bor and a copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 8, 2025

Allegation investigated: - Staff did not call 911 for residents -Staff took resident's call pendant - Staff did not notify resident authorized - Staff is opening resident's mail representative of incidents - Staff is being disrespectful to resident - Staff are over dosing residents - Facility is not at a comfortable temperature for resident's - Staff are not providing adequate food service for resident's - Staff is financially abusing resident - Staff are not meeting resident's toileting needs - Staff are charging resident for services not received - Staff did not have resident's authorized represtantative sign admissions agreeemnt for change in level of care

Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to conclude the investigation into the above identified complaint allegations. LPA arrived at the facility and was greeted and granted entry by care staff. LPA spoke with Elena Bor, Administrator and explained the purpose of the visit. Findings are based upon this investigation which included tour of the facility, facility file review, resident file review, interviews conducted, and pertinent documents collected. It is alleged staff did not call 911 for resident. Record review revealed that licensee/administrator has submitted various LIC624 unusual incident reports for the year 2022. Interview with staff stated that Continued on LIC9099-C Unsubstantiated resident (R1) didn’t have an incident that need 911 to be call or reported out to the department. Interview with R1 stated that they did not have any incidents that needed the assistance of 911. Interview with 3 of 3 residents stated that owner calls 911 when necessary and when it is needed. It is alleged that staff did not notify residents authorized representative of incidents. Interview with witnesses stated that facility licensee calls them and keeps them informed. Review of the records revealed that reports state that responsible party and/or authorized representative were notified. Interview with Administrator stated that they kept families, representatives and/or authorized representative informed of any incidents, changes in condition or any information. It is alleged that staff are overdosing residents, specifically with giving R1 sleeping medication. Interview with 3 of 3 residents indicated that staff give them medication and they have not had any issues with medication. Record review revealed that there is no medication on record for sleep aid for any resident. Medication list do reflect medication for agitation and anxiety but not sleeping aids. Records reflect consistency with medication list and very minor changes are reflected. It is alleged that staff are not providing adequate food service for resident’s, specifically to licensee providing food from their own home and family meals. Interview with licensee stated that they have always lived on the second floor of the facility and they do not have another family home in where they would go to and make meals to bring back. Interview with 3 of 3 residents stated that the meals provided are good and they have no issues with the food. LPA toured the facility kitchen and observed that the meal prepared appeared of good quality and storage areas organized. LPA inspected food supply adequate amount was observed to be within regulations. The facility has a two-day supply of perishables, and seven-day supply of non-perishable food is available as required by regulations. It is alleged that staff are not meeting resident’s (R2) toileting needs. Record review revealed that R2's fees reflect for level 2 minimal care and supervision. Residents at this level are mildly confused, need verbal Continued on LIC9099-C reminders to perform hygiene functions, uses walker or wheelchair, has occasional episodes of incontinence, mild emotions or behavior issues, medically stable, special diet or weight issues. Interview with R2 stated that they get the help they need and get help when they need to go to the bathroom. Interview with 3 of 3 residents stated that they get help when they need it. It is alleged that staff are charging resident for services not received, specifically to night supervision. Interview with licensee/administrator stated that they do the night shift, they live in the facility and provide the care at night. . Interview with Interview with 3 of 3 residents stated that they get the care they need at night and/or have seen the staff providing care at night to the residents. It is alleged that staff did not have resident's authorized representative sign updated admissions agreement for change in level of care. Record review revealed that LPA obtained copies of resident that resided at the time of filed complaint from the facility. It was observed that only one resident reflected a changed of level of care. Records revealed that resident (R3) had a change of level in care on June 1st and paperwork was signed. R3 admissions to facility was March 2, 2022. It is alleged that staff took resident’s call pendant, specifically to resident (R4). Interview with resident stated that they never had a call pendant. Interview with staff stated that there was residents that had a call pendant. It is alleged that staff is opening resident’s mail, specifically to R4’s mail. Interview with resident stated that their mailing address is their home and not the facility. Their mail gets retrieved from the home and brought back to the facility with them. Interview with staff stated that residents do not get their mail sent to the facility but that they had that option to do so. However, most residents family choose not to and bring residents mail if necessary to the resident to the facility. It is alleged that staff is being disrespectful to residents. Interview with 4 of 4 residents stated that the staff is good to them, are not rude to them at all and they treat them with respect at all times. Interview with staff stated that they do the best they can and treat all residents with respect and do the best they can to keep all residents well cared for and happy. Continued on LIC9099-C It is alleged that facility is not a comfortable temperature for resident’s. Interview with staff stated that the facility has a central air system to control the entire house. Interview with 4 of 4 residents stated that the temperature is never too cold or too hot that it is fine for them. LPA toured the facility and observed the temperature outside was 66.9 Fahrenheit degrees and the temperature inside the facility measured at 73.9 Fahrenheit degrees which is within regulations. It is alleged that staff is financially abusing resident, specifically monthly dues checks paid to the Administrator. Record review revealed that Administrator is also the licensee of the facility and therefore fees are paid to the licensee. Based on the information mentioned above, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed Unsubstantiated. An exit interview was conducted with the Administrator and a copy of this LIC9099 report was left at facility.the state’s words, verbatim · CDSS document, Oct 21, 2025 · control 22-AS-20220512152957

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Administrator Elena Bor and explained the purpose for today’s visit. The facility is licensed to serve 6 Non-Ambulatory Residents, with a Hospice Waiver for 6. The facility currently has 6 Residents, 5 of which receive Hospice Services. The facility is a two-story home located in Fullerton, Ca (only the first floor is licensed to provide care and supervision). A tour of the facility includes: Living room, 2 dining areas/room, 5 Resident Bedrooms (1 is a shared room), 4 full baths located in 4 of the resident bedrooms, 1 full bathroom, front yard, back yard, detached garage, and a pool (which is fully fenced). 2nd floor is private residence for Administrator. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit todays visit and the initial visit and observed the following: Infection Control: Facility has sufficient PPE supplies and Infection Control Plan maintained at the facility. Operational Requirements: The facility has an approved fire clearance and maintain the required liability insurance. During resident file review it was observed that Resident #1 is bedridden, per their physician report dated 8/21/24, facility has fire clearance for Non-Ambulatory Residents Only, citation will be issued along with civil penalties as facility is operating outside of what they are approved for. Staffing: There appears to be sufficient staffing at all times in the facility. Personnel Records-Training: Staff has criminal record clearance, current First-Aid/CPR/AED training along with training in dementia, hospice care, medication assistance, and other ongoing training are documented in personnel files. LPA reviewed 4 staff files with no issues observed. Administrator Elena Bor certificate expires 6/17/24. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. (Continued on LIC809-C) Physical Plant & Environment Safety: LPA toured facility, residents’ bedrooms were checked and closet/drawer space to accommodate each resident comfortably was available. The front yard is free of debris/hazards and the outdoor and passageways are free of obstruction. Facility has a pool in the back yard that is completely fenced and locked. There are no security bars or weapons on the premises. Hygiene products are readily available for clients. The hot water temperature was tested throughout the facility and, 1/2 of the facility measured below the required range of 105-120 degrees F, measuring at 80-86 degrees F, citation will be issued. All storage areas for cleaning solutions, toxins, knives, and hazardous items are kept in a locked and are inaccessible to residents. Smoke detectors and carbon monoxide detectors are operable and in compliance. There fire extinguisher was observed and is fully charged. Last fire/disaster/earthquake drill was conducted on 6/26/24 citation will be issued. Resident Records-Incident Reports: Resident files are kept in a secure location and have the following documents in their files - Pre-admission appraisal/Appraisal Needs & Services Plan, Admission Agreements, Identification & Emergency Information and current Physician's Report. LPA reviewed 4 Resident Files with no issues observed. Residents Rights-Information: Residents are provided with telephone and internet at the facility. The facility has the following posters posted: Residents Rights, Complaint Poster, and Ombudsman. Planned Activities: Facility provides scheduled activities and have a variety of activities to choose from within the facility. There is an outdoor activity area available for the residents. Incidental Medical & Dental: Medication is properly labeled and are centrally stored in a locked cabinet and are in their original containers. LPA reviewed residents’ medications and there were no issues observed. Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. Residents with Special Health Needs: There is 1 bedridden at this facility. Facility has 5 residents using hospice services and maintain the required hospice care plan. Per California Code of Regulations, Title 22, and California Health and Safety Code, deficiencies observed during the visit will be documented in the LIC809D. Civil Penalties were issued during visit. Exit interview held and a copy of the report, LIC421IM (Civil Penalty Assessment), and appeal rights were provided to Administrator Elena Bor.the state’s words, verbatim · CDSS document, Dec 16, 2024

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.