Amazing Grace Elder Care #2

Type of visit: Required - 1 Year

On July 31, 2026, at 2:00 PM, Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual required inspection. LPA Martinez met with Nathaniel Sterling and explained the purpose of today's visit. LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. Administrator holds current certificate. The facility is licensed for six non-ambulatory client, which one may be bedridden. There are currently six residents who reside at this facility. The facility has an approved hospice waiver for two. For administrator changes, the Regional Office requests the following documentation to be submitted by August 07, 2026 by 5:00 PM. A letter from the licensee and/or Board appointing the individual as the Administrator LIC 308 Designation of administrative responsibility Copy of current Administrator Certificate Any documentation that meets the education and/or experience requirements, if applicable LIC 200 signed by the licensee or designee LIC 500 to indicate the days/hours the administrator is in the facility LIC 501 Personnel Application Continued... The LPA Martinez toured the facility with Nathaniel Sterling on July 31, 2026, at 3:00 PM. LPA Martinez reviewed two out of two resident files. Two out of two resident files did not contain a LIC 625 appraisal/needs and service plan. LPA Martinez reviewed two out of two medication administration records, and both records were kept current. LPA Martinez reviewed two out two staff files. The facility has an disaster plan and infection control plan. The facility has a first aid kit, and medications are stored in a locked cabinet. The facility common areas, resident bedrooms, and bathrooms are furnished and sanitized. The smoke detectors and carbon detectors are in good repair. The facility has an adequate food supply. The facility temperature measured at 75 degrees. The facility water temperature measured at 105 degrees. LPA Martinez requested the following document: Current Liability Insurance; LIC 308 Designation of Administrative Responsibility; LIC 500 Current Personnel Report; Copy of Administrator Certificate. Please email requested document to LPA Martinez by August 07, 2026. Based on this annual inspection there were no citations give and two technical violations were given. An exit interview was conducted, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jul 31, 2026

Allegation investigated: ) Staff does not maintain a comfortable room temperature for residents. 2) Staff gives residents another resident’s food.

Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced complaint inspection at Amazing Grace Elder Care #2 RCFE on 8/29/25 at 11:30am to inform the licensee of complaint allegations mentioned above. Based on the interviews conducted during the investigation process and statements obtained during the investigation process, LPA Gould was unable to corroborate the allegations. LPA immediately checked the facility thermostat and observed a temperature of 71 degrees that meets title 22 regulations. LPA observed the facility to be comfortable and reasonable temperature given the time of day and season. LPA inspected the food supply and observed adequate supply of perishable and non-perishable foods. LPA observed staff members preparing a fresh lunch. LPA observed a food supply of frozen burritos and taco stored in the fridge. LPA informed staff for food safety items must be stored as directed. Staff informed LPA that food supplies belong to R1 and will be upset if moved. Report Continued on LIC 9099-C. Unsubstantiated LPA Gould met with R1 and attempted to explain the purpose of visit. LPA began to question R1 regarding food supply and R1's concern with food. R1's statements to LPA were not corroborated by LPAs observations of food supply. R1 grew increasingly agitated in LPAs presence and LPA exited the facility for safety purposes and R1 followed LPA to their vehicle. R1 was redirected inside by staff members. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of personal rights are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies is cited per California Code of Regulations, TITLE 22. Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Aug 29, 2025 · control 27-AS-20250825161456

Type of visit: Required - 1 Year

On 7/25/25 at 9:15am Licensing Program Analyst (LPA) Kevin Gould arrived at Amazing Grace Elder Care 2 for the purpose of conducting a required 1 year annual inspection. LPA met with Administrator, Nate Sterling and together conducted a tour of the home. LPA and Administrator evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA measured the water temperature, temperature measured at 107 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications secure from residents. Per California Code of Regulations, Title 22 there were no deficiencies cited during today's inspection. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jul 25, 2025

Allegation investigated: Licensee is in financial distress.

Licensing Program Analysts (LPA) Kevin Gould made an unannounced inspection to the Amazing Grace Elderly Care #2 RCFE on 4/11/25 at 9:00am to conclude the investigation of the above allegation and to deliver the findings. LPA Gould met with staff, Rino De La Cruz and together discussed the investigation details. Based on the interviews conducted during the investigation process and statements obtained during the investigation process, LPA Gould was unable to corroborate the allegations. LPA requested several months of banking records which did indicate the facility did have sufficient funds to maintain the facility. LPA also requested several months of utility records which did indicate the licensee is paying all required bills in a timely manner and all bills showed a zero balance at each billing cycle. Report Continued on LIC 9099-C Unsubstantiated LPA inspected the facility food supply and observed the food supply to meet the population served. LPA conducted interviews with one staff member who provided statements there was only one delay in payroll but he was paid in full and was just an issue from the licensee being out of town and a holiday weekend. Staff interviewed denied that this is a recurring issue at this facility. LPA interviewed one resident who provided statements to LPA that they like the food at the facility and there are always plenty of food available at the facility. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of financial issues are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies is cited per California Code of Regulations, TITLE 22. Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Apr 11, 2025 · control 27-AS-20250219115840

Allegation investigated: ) Staff engaged in an inappropriate relationship with resident. 2) Staff are mismanaging resident's medication. 3) Staff did not keep resident's personal information confidential 4) Staff are not meeting resident's needs 5) Staff did not ensure the facility is kept clean. 6) Staff did not ensure the facility was free of rodents 7) residents are working as manintenance staff; moving the lawn, getting groceries, cutting a tree. 8) staff do not have appropriate training as required.

Licensing Program Analysts (LPA) Kevin Gould made an unannounced inspection to the Amazing Grace Elderly Care II RCFE on DATE at TIME to conclude the investigation of the above allegations and to deliver the findings. LPA Gould met with Staff, Rino De La Cruz and together discussed the investigation details. Based on the interviews conducted during the investigation process and statements obtained during the investigation process, LPA Gould was unable to corroborate the allegations. LPA conducted an interview with the alleged vicim (R1), (see confidential names list, LIC 811 dated 4/11/25) in regards to staff having an inappropraite relationship with a staff member. R1 denied the allegation and stated they were just friends and got along well. LPA was unable to conduct a staff interview with the former staff member as the number on file is no longer in service. Staff interviewed denied witnessing or any knowlege of an inappropraite sexual relationship between any staff member and a resident at the faclility. Report Continued on LIC 9099-C Unsubstantiated Regarding allegation that facility mismanaged a resident's medication, LPA reviewed medication administration records for all residents and conducted inventories of medications. LPA observed the medication administration records to be complete and documented. LPA did not observe any errors with medications. LPA reviewed staff files and observed all required training in place to meet regulations for the staff members present at the facility. LPA attempted to contact former staff member but was unable to conduct an interview with the former staff member. LPA was unable to corroborate the allegation. Regarding allegation that resident information was not kept confidential, LPA observed in the facility that all client records are locked an inaccessible to clients in care. S1 and S2 denied any knowledge of listing in on a meeting with placement agency and facility. LPA attempted to interview former staff member but was unable to conduct an interview with the former staff member. LPA was unable to corroborate the allegation. Regarding allegation that the facility was not meeting residents needs, LPA conducted interviews with six residents and all but the alleged victim denied the allegation. The alleged victim had minimal needs and services identified as R1 was independent with all ADLs, and continued to be active and drive in the community. LPA was unable to identify any unmet needs of residents in care as documented in the resident's appraisals and needs and services plan. LPA was unable to corroborate the allegation. Regarding the allegations the facility was not kept clean and was not kept free of rodents. LPA conducted an annual inspection just prior to receiving the complaint and did not observe any evidence of rodents and observed the facility to meet the cleanliness standards established by the department. LPA also obtained records from the facility documenting the existing pest control that is utilized by the facility on an ongoing basis. LPA was presented with pictures of rodent droppings but was unable to confirm the location of the images as they were very close up and provided no indication they were actually from the facility. additionally, LPA was presented with a photo of a mouse captured in a trap which does indicate the facility was addressing the presence of rodents in and around the facility in a timely manner. Regarding the allegation that alleged victim was working as maintenance staff LPA was unable to corroborate the allegation. Reporting party indicated R1 was paid $100 a month to perform these services which was denied by R1 and S1. R1 did indicate he wanted to help out around the facility and had a background in handiwork. Licensee denied requesting or demanding that R1 perform theses duties and denied any staff member would request R1 to perform such tasks. Report Continued on LIC 9099-C The department does encourage activities for residents that may include such activities like gardening and outings. LPA observed R1 was independent with transportation and driving and there are no regulations that would prevent a resident on going on outings or purchase own food in addition to what is being supplied by the facility. Finally, LPA reviewed staff records and observed all documented training for staff members present and met department regulations. LPA was unable to corroborate the allegation that staff were not adequately trained to meet resident needs. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of (indicate the complaint allegation) are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies is cited per California Code of Regulations, TITLE 22. Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the facility. The following deficiency is cited per California Code of Regulations, TITLE 22. Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the home.the state’s words, verbatim · CDSS document, Apr 11, 2025 · control 27-AS-20240809112033

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(f) · Plan of correction due date: Apr 18, 2025

Eviction Procedures: A written report of any eviction shall be sent to the licensing agency within five (5) days. This requirement was not met as evidenced by LPA and the department did not receive notification of the resident eviction within 5 days of providing the notice to the resident wich poses a potential health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 11, 2025

Plan of correction: Licensee will provide a written plan of correction indicating the steps facility will make in the future to ensure that any future eviction will meet all department requirements. POC due date 4/18/25.

Type of visit: POC

On 7/25/24 at 9:00am, Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced POC inspection to ensure previous deficiencies have been corrected. LPA conducted a walk through of the home and observed the refrigerator moved to create a open walking space in the kitchen. Staff bedroom door has been repaired and is working as designed. LPA also observed the camera in the front entry way has been relocated and no longer poses a potential personal rights risk to residents in care. All deficiencies have been cleared and a POC clearance letter was provided to the facility. Exit interview conducted and a copy of this report was left at the home.the state’s words, verbatim · CDSS document, Jul 25, 2024

Type of visit: Required - 1 Year

On 7/19/24 at 9:00am Licensing Program Analyst (LPA) Kevin Gould arrived at Amazing Grace Elder Care #2 for the purpose of conducting a required 1 year annual inspection. LPA met with Administrator, Patricia Matias and together conducted a tour of the home. LPA and Administrator evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor and clean. LPA observed the door to the staff bedroom is broken and in need of repair. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA observed there are currently two refrigerators and a freezer in the kitchen/living room; the freezer is blocking a passageway and should be moved to accommodate residents and ensure residents can safely ambulate in the kitchen. also observed a camera in the entry way with a direct view of a resident bathroom. LPA requested the camera be removed. LPA measured the water temperature, temperature measured at 114 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications secure from residents. All resident and staff files were complete and well organized. LPA Requested the following documents for facility file: LIC 308 Designation of Facility Responsibility, LIC 500 personnel report, LIC 9020 client roster and current administrator certificate. Per California Code of Regulations, Title 22 the following deficiencies are cited during today's inspection. An exit interview was conducted, and a copy of this report and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Jul 19, 2024