Amazing Grace Home Care

Type of visit: Required - 1 Year

On 11/17/2025 at 09:45 am Licensing Program Analyst (LPA) Lorena Casillas met with administrator Aldrin Perez for an unannounced one (1) year Required visit for this facility. LPA was greeted and granted access by Administrator. LPA explained the reason for the visit and an entrance interview was conducted. At 10:00 am LPA conducted a facility tour with the Administrator, and the following was observed. There are five (5) residents in the facility. Four (4) residents are non-ambulatory, none of which are in hospice care and one (1) resident is ambulatory. LPA observed all residents to be in their rooms watching TV or sleeping. Facility is cleared for six (6) non ambulatory residents of which three (3) can be bedridden and an approved hospice waiver for two (2) residents. Infection control: The facility has an Infection Control Plan approved on 03/30/2021. Proper signage was observed inside along the hallway and in the restrooms. Kitchen: LPA observed the kitchen to be clean and clear of clutter. All appliances were operative. Cleaning solutions are locked under the sink. Knives are kept locked in the garage and inaccessible to residents. LPA observed smoke alarms throughout the facility that are interconnected. At 10:20 a.m. all smoke alarms were tested and functioned properly. LPA observed one carbon monoxide detector, and it was tested and proved to be functioning. Bedrooms: There are five (5) bedrooms designated for resident use. One (1) out of the five (5) rooms is shared. All resident rooms are furnished with required lighting, dresser, chair, bed, and linens. Continued on LIC809-C Dining / Living Area: The dining and living area were well lit, clean, and clear of clutter. Furniture appeared clean and in good repair. A fireplace located in the living area is covered and not in use. LPA observed the thermostat at a comfortable temperature of 72°F. There is a fire extinguisher located near the main entrance, and it was last purchased on 11/25/2024. Bathrooms: There are two (2) bathrooms designated for resident use. One (1) bathroom is located in the shared bedroom, and the other main bathroom is accessible to all the residents. Both bathrooms were well lit and clean, had grab bars, hand washing signs, nonskid mats, and trash bins with lids. LPA observed a sufficient supply of hand soap and paper towels. Water temperature in the bathrooms was measured at 110.7˚ Fahrenheit. Laundry Room: LPA observed the laundry room to be locked and inaccessible to residents. Garage: LPA observed garage to be used for extra storage. There is a freezer stocked with appropriately labeled food. There is an additional supply of canned goods. Surrounding Grounds: There were no visible hazards, and passageways were free from obstruction. Side gates on either side of the house were closed but unlocked. There is a covered patio to provide shade and appropriate outdoor seating for residents. LPA observed two sheds in the backyard, one (1) for storage and another one (1) being used as an office. Administrative: Annual fee does not reflect current, however Administrator provided proof that payment was mailed on 11/06/25. LIC 500, Liability Insurance and Resident roster were collected. Staff Files: LPA conducted a file review of staff records at 11:30 am. Resident Files: LPA conducted a file review of resident records at 12:00 pm. Medications: At 2:00 pm LPA and Administrator reviewed medication and medication records for proper documentation. Staff/Resident Interviews: At 2:25 pm LPA interviewed staff and residents. No citations issued. Exit interview conducted and a copy of this report given to Administrator.the state’s words, verbatim · CDSS document, Nov 17, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Lorena Casillas met with administrator Aldrin Perez for an unannounced one (1) year Required visit for this facility. LPA arrived at 09:20 am and was greeted and granted access by Administrator. There are five (5) residents in the facility. Three (3) residents are bedridden, two (2) of which is in hospice care. Two (2) residents are ambulatory. LPA observed all residents to be in their rooms watching TV or sleeping. Infection control: The facility has an Infection Control Plan approved on 03/30/2021. Proper signage was observed inside along the hallway and in the restrooms. Kitchen: LPA observed the kitchen to be clean and clear of clutter. All appliances were operative. Cleaning solutions are locked under the sink. Knives are kept locked in a kitchen cabinet inaccessible to residents. LPA observed smoke alarms throughout the facility that are interconnected. At 11:30 a.m. all smoke alarms were tested and functioned properly. LPA observed one carbon monoxide detector and it appeared to be functioning. Dining / Living Area: The dining and living area were well lit, clean, and clear of clutter. Furniture appeared clean and in good repair. A fireplace located in the living area is covered and not in use. LPA observed the thermostat at a comfortable temperature of 75°F. There is a fully charged fire extinguisher located near the main entrance that was last purchased on 11/21/2024. Continued on LIC809-C Bedrooms: There are five (5) bedrooms designated for resident use. One (1) out of the five (5) rooms is shared. All resident rooms are furnished with required lighting, dresser, chair, bed, and linens. Bathrooms: There are two (2) bathrooms designated for resident use. One (1) bathroom is located in the shared bedroom and the other main bathroom is accessible to all the residents. Both bathrooms were well lit and clean, had grab bars, had hand washing signs, nonskid mats, and trash bins with lids. LPA observed a sufficient supply of hand soap and paper towels. Water temperature in the main bathroom was measured at 118.5 degrees Fahrenheit. Laundry Room: LPA observed the laundry room to be locked and inaccessible to residents. Garage: LPA observed garage to be used for extra storage. There is a freezer stocked with appropriately labeled food. There is an additional supply of canned goods. Surrounding Grounds: There were no visible hazards, and passageways were free from obstruction. Side gates on either side of the house were closed but unlocked. There is a covered patio to provide shade and appropriate outdoor seating for residents. LPA observed two sheds in the backyard, one (1) for storage and another one being used as an office. Administrative: Annual fee is not current. LPA provided Administrator with PIN and payment was made during LPA visit. Administrator provided LPA with confirmation # 950982. LIC 500, Liability Insurance and Resident roster were collected. Staff Files: LPA conducted a file review of staff records at 1:05 pm. Resident Files: LPA conducted a file review of resident records to ensure compliance of licensing forms at 1:30 pm. Medications: At 2:30 pm LPA and Administrator reviewed medication and medication records. Staff/Resident Interviews: At 2:50 pm LPA interviewed staff. Exit interview conducted and a copy of this report issued.the state’s words, verbatim · CDSS document, Nov 21, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Lorena Casillas met with administrator Aldrin Perez for an unannounced one (1) year Required visit for this facility. LPA arrived at 12:10 pm and was greeted by a caregiver. Caregiver called Administrator and LPA informed the Administrator of the purpose of the visit. Administrator arrived at 1:10 pm. At 12:35 p.m. LPA began a physical plant tour of the facility, and the following was observed: There are five (5) residents in the facility. Three (3) residents are bedridden, one (1) of which is in hospice care. Two (2) residents are non-ambulatory. LPA observed all residents to be in their rooms watching TV. Kitchen: LPA observed the kitchen to be clean and clear of clutter. All appliances were operative. Knives are kept locked in a kitchen cabinet inaccessible to residents. LPA observed smoke alarms throughout the facility that are interconnected. At 1:55 p.m. all smoke alarms were tested and functioned properly. LPA observed one carbon monoxide detector and it appeared to be functioning. There is a fire extinguisher located in the kitchen last purchased on 05/24/2023. Dining / Living Area: The dining and living area were well lit, clean, and clear of clutter. Furniture appeared clean and in good repair. A fireplace located in the living area is not in use and is blocked off making it inaccessible to residents. LPA observed the thermostat at a comfortable temperature of 76°F. There was a fire extinguisher observed by the entrance and was last purchased on 5/24/2023. Bedrooms: There are five (5) bedrooms designated for resident use. One (1) out of the five (5) rooms is shared. All resident rooms are furnished with required lighting, dresser, chair, bed, and linens. Continued on 809-C... Bathrooms: There are two (2) bathrooms designated for resident use. One (1) bathroom is located in the shared bedroom and the other main bathroom is accessible to all the residents. Both bathrooms were well lit and clean, had grab bars, had hand washing signs, nonskid mats, and trash bins with lids. LPA observed a sufficient supply of hand soap and paper towels. Water temperature in the main bathroom was measured at 115.5 degrees Fahrenheit. Laundry Room: LPA observed the laundry room to be locked and inaccessible to residents. Garage: LPA observed garage to be used for extra storage. There is a freezer stocked with appropriately labeled food. There is an additional supply of canned goods. Surrounding Grounds: There were no visible hazards, and passageways were free from obstruction. Side gates on either side of the house were closed but unlocked. There is a covered patio to provide shade and appropriate outdoor seating for residents. LPA observed two sheds in the backyard, one (1) for storage and another one being used as an office. Administrative: Annual fee is current. LIC 500, Liability Insurance and Client roster were collected. Staff Files: LPA conducted a file review of staff records at 2:15 pm. Resident Files: LPA conducted a file review of resident records to ensure compliance of licensing forms at 2:35 pm. Medications: At 3:05 pm LPA and Administrator reviewed medication and medication records for proper documentation. Staff Interviews: At 3:20 pm LPA interviewed staff. Client Interviews: At 3:45 pm LPA interviewed residents. Exit interview conducted and a copy of this report issued.the state’s words, verbatim · CDSS document, Feb 14, 2024