Amazing Grace Care Services

Type of visit: Required - 1 Year

On 6/18/2026, Licensing Program Analyst (LPA) E. Conchas made an unannounced visit to the facility. The purpose of the visit was to conduct the required comprehensive annual inspection. LPA met with House manager Teresita Espinoza and was granted entry to the facility. At the time of the visit there were two (2) staff present, and four (4) residents present. The facility is five (5) bedrooms, three (3) bathroom home with a kitchen/dining area, living room/activity room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) ambulatory of which four (4) can be non-ambulatory, two (2) hospice care waiver and the current census is five (5) residents. LPA was accompanied by a staff to conduct a general overall inspection, which included, but was not limited to the following: There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 75 degrees F. LPA inspected resident bedrooms in which they are equipped with the required furniture. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperatures in the restrooms to be at 140 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. One (1) fire extinguisher was observed at the facility. LPA observed the facility license, facility administrator, personal rights, the CCLD complaint poster, facility sketch and the ombudsman posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine cabinet with the resident’s medications locked. LPAs observed first aid kit and first aid book at the facility. Continue to LIC809C Seven (7) days’ supply of non-perishable foods and two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. The facility has enough staff to provide care and supervision to the residents in care. Also, LPA observed that the facility has a dementia resident. LPA reviewed resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPA observed the residents centrally stored medications and MAR. LPA reviewed staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings. The following was observed and cited · Type B was issued. LPA observed two (2) resident restrooms where the water measured at a temperature of 140 degrees F. · Type B. LPA observed one (1) resident MAR (R5) that was initialed by staff indicating the medication was given during the time the R5 was not at the facility. · Type B. LPA observed R1, R3 and R5 appraisals to be incomplete. · Type A. LPA observed R1 and R3 to not have their TB completed. Based on the observations made during today’s visit, four (4) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report and Appeal Rights were discussed and provided to House Manager, Teresita Espinoza.the state’s words, verbatim · CDSS document, Jun 18, 2026

Type of visit: Required - 1 Year

On 10/6/2025 at 9:05 AM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA met with Supervisor Teresita Espinoza and was granted entry to the facility. At the time of the visit there was two (2) staff present, and four (4) residents present. The facility is a five (5) bedrooms, three (3) bathroom home with a kitchen/dining area, living room/activity room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) ambulatory of which four (4) can be non-ambulatory, two (2) hospice care waiver and the current census is four (4) residents. LPA was accompanied by a staff to conduct a general overall inspection, which included, but was not limited to the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 74 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with the required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean. LPA observed that the toilet by the front door is not working. Citation issued. LPA observed sufficient furniture and lighting throughout the facility. LPAs measured and observed the water temperatures in the bathroom to be at 118 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Fire extinguisher was also observed at the facility. Posters such as personal rights, the CCLD complaint poster, and the disaster plan were posted in a common area. ***Continuation in LIC809C *** Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine cabinet with the resident’s medications locked. LPAs observed first aid kit and first aid book at the facility. Food Service: Seven (7) days’ supply of Non-perishable foods and two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. LPA observed that the facility does not have enough 72 hour emergency food and water. Citation issued. Care & Supervision: The facility has an Supervisor present in the facility with enough hours to appropriately manage the facility. The facility has sufficient number of staff to provide care and supervision to the residents in care. Also, LPA observed that the facility has dementia residents. Record Review: LPA reviewed four (4) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPA observed resident #3 (R3) and resident #4 (R4) admission agreements were not completed and not signed. Citation issued. LPA observed that the physician's report for R3 and R4 were missing in their file for review. Citation issued. LPA observed that the centrally stored medication lists were not completed for all residents in care. Citation issued. LPAs reviewed four (4) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA found that all the staff did not have the health screening report. Deficiency will be issued. LPA observed that the required training for all the staff were not dated and does not have the description of which training were completed. Deficiency issued Based on the observations made during today’s visit, nine (9) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC809, LIC809D forms, and Appeal Rights were discussed and provided to supervisor Teresita Espinoza.the state’s words, verbatim · CDSS document, Oct 6, 2025

Allegation investigated: Staff do not store medications so they are inaccesible to residents

Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to initiate and deliver findings for the mentioned allegation. LPA met Pauline Beltran-Support Staff who was informed of the purpose of the visit and allegation. The investigation consisted of observations,record review and interviews with support staff who stated on 9/11/2024 some medications for the residents were placed in a drawer in the refrigerator unlocked accessible to the residents, but as of 9/12/2024 the licensee has taken measures to ensure medications are locked. During the visit LPA observed in the refrigerator medications stored in a clear box with a combination lock. Based on the information obtained during the investigation a citation was issued for not ensuring medications were inaccessible to residents in care. Substantiated Based on the evidence gathered during the investigation, the above allegation is found to be Substantiated. A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. An exit interview was conducted where this report LIC9099, LIC9099-C and LIC9099-D was discussed and provided to Pauline Belran at the conclusion of the visit with appeal rights.the state’s words, verbatim · CDSS document, Sep 25, 2024 · control 56-AS-20240917110657

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(2) · Plan of correction due date: Oct 2, 2024

87465- Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons.... This requirement was not met as evidenced by: based on interviews and record review the licensee didn't ensure medications were inaccessible to residents in care which pose potential health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 25, 2024

Plan of correction: The licensee has purchased a lockbox for medications to be stored in the refrigerator. The licensee has also agreed to provide training on the cited regulation & provide a signed statement of understanding by all staff members and provide proof of training by the POC date of 10/2/2024.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Teresa Espinoza, Supervisor, and discussed the purpose of the visit. The facility is a single story, (5) bedroom, (3) bathroom, Residential Care Facility for the Elderly (RCFE) with a license capacity of (6) and a current census of (5) residents in care. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following: Physical Plant/Environment: Indoor and outdoor passageways are free of obstruction. The facility has no swimming pools or similar bodies of water. Outdoor shaded area is sufficient for resident activities and is enclosed with a self-latching gate. The facility has sufficient lighting and is maintained at a comfortable temperature. Resident’s showers, toilets, and hand washing areas were in operating condition and equipped with grab rails and non-slip mats. The hot water temperature in residents' bathrooms measured 108 and 117 degrees F. Resident’s bedrooms had beds, bed linen, dressers and sufficient lighting. The facility has operating carbon monoxide alarms and telephone service. The facility has sufficient linen, towels, and personal hygiene items for residents. The facility has posted in a common area, facility license, Community Care Licensing complaint poster, Ombudsman poster, Resident's Personal Rights, evacuation exit plan and emergency telephone numbers. Sharps, disinfectants, and cleaning solutions are kept in a locked cabinet inaccessible to residents in care. Food Service: Facility kitchen and dining areas are maintained clean. The facility has sufficient non-perishable and perishable food supply for residents in care. The facility's refrigerator and freezer were operating in a healthful manner. Care & Supervision: Facility has 24-hour, 7 days a week care staff, staff present at the facility had criminal record clearances with the Department. Medical Related Services: Resident’s medications are labeled and centrally stored in a locked cabinet. Record Review: The facility’s Administrator’s certification and liability insurance are current. The facility’s last fire drill was conducted on 1/10/24. LPA review of staff files reveals, staff #1 (S1), staff #2 (S2), and staff #3 (S3) did not have record of tuberculosis results and did not have an employment record/application containing Employee's full name, Social Security number, date of employment, home address on file. In addition, the facility did not maintain record of S3's first aid/CPR and dementia training. LPA review of resident files reveal, resident #1 (R1), resident #2(R2), resident #3(R3), resident #4 (R4) did not record of tuberculosis results. In addition, the facility did not maintain record of a pre-admissions appraisal for R1. LPA review of facility's hospice waiver reveals the facility has an approved hospice waiver for (2) residents; however, all (5) residents are receiving hospice care. Based on observations and record review, deficiencies are being cited per Title 22, of The California Code of Regulations and Health and Safety codes. This report was reviewed with Supervisor Espinoza and a copy with Appeal Rights was provided to Supervisor Espinoza and the conclusion of the visit.the state’s words, verbatim · CDSS document, Apr 23, 2024

The state marks this report as 10 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.