Evening Grace Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. LPA met with staff designee and was explained the reason for the visit. At 1:30 PM, with the assistance of designee, LPA took a tour of the physical plant. Required postings were observed in the entry area. At 1:47 PM the smoke alarms were tested and are operational that are located each bedroom, the hallway and kitchen. There are carbon monoxide detectors that functions properly. The fire extinguisher is in the kitchen. The charge date is 1.12.2026. During the visit the facility is at 73 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory residents; 6 may be bedridden and is cleared for 6 hospice waiver. Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked cabinet in the kitchen. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers. Cleaning supplies, pesticides or toxic cleaning supplies were stored and locked away in the kitchen. Bedrooms: There were eight (8) bedrooms designated for residents' use. Bedroom #1, bedroom #2, bedroom #3, bedroom #4, bedroom #5, and, bedroom #6 are for private used by residents were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Bedroom #7 and bedroom #8 is for staff used and is located in the second floor. Continue to LIC 809-C Bathrooms: There are nine (9) bathroom designated for residents' and staff use. The bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at an average of 113.9 degrees Fahrenheit for the bathrooms. Bathroom #7, bathroom #8 and bathroom #9 is for staff and visitor, located beside the lock laundry room and in the first floor and second floor. Common Areas: LPA toured all common areas of the facility. These included the living room and dining area for residents. The common areas were properly furnished. Residents dining table fits enough for six (6). LPA observed common areas to be very clean and tidy. LPA observed the floors to be in very good condition. No obstructions and or tripping hazards throughout the facility. Furniture in common area was observed to be in good repair. No fireplace in the facility. There are no issues with Fire Clearance. Infection control: Facility mitigation plan to make sure licensee was following current infection control recommendations. LPA obtain a copy and reviewed the infection control plan during this visit. Surrounding Grounds: Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The facility does not have a swimming pool or body of water. The garage detached and is used for storage. Laundry service: There is enough linen available to change weekly or more if need. Cleaning supplies are being stored in a locked cabinet in the laundry area and is located beside the dining area. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Office space is beside the den. Records were checked for expired or missing certificates and clearances: LPA conducted a file review of staff for criminal record clearances and current First Aid. The administrator file was reviewed for current first aid, fingerprint clearance, administrator certificate, and HIV/AIDS and TB training. Medications are in a centrally stored and locked place, including over-the-counter medicines; medications are properly labeled and checked for expiration dates. Each centrally stored prescription and PRN medication has been logged in the medications log with proper documentation from the clients’ doctor. Proper medication dispensing instruction are followed and checked for contamination. First-aid has all proper items and is current. Continue to LIC 809-C Resident records were reviewed for requirements and legibility: LPA reviewed client’s files for current appraisal. Planned activities are offered. Facility is within CA code of Regulations Title 22 or Health and Safety Code. No deficiencies were found, exit interview conducted, copy of report has been issued and discussed.the state’s words, verbatim · CDSS document, Jan 14, 2026

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPAs) Leslie Ngo-Castaneda and Angelica Segovia conducted an continuation annual required visit and inspection of the facility. At 1:40 PM Maria Elizabeth Sarmiento who is the staff designee met with LPA, explained the reason for the visit. At 11:45 AM, with the assistance of administrator, LPAs took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are operational that are located each bedroom, the hallway and kitchen. There are carbon monoxide detectors that functions properly. The fire extinguisher is in the kitchen. The charge date is 10/13/2024. During the visit the facility is at 76 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory residents; 6 may be bedridden and is cleared for 6 hospice waiver. Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPAs found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked drawer in the kitchen. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers. Cleaning supplies, pesticides or toxic cleaning supplies were stored and are locked away under the kitchen. Bedrooms: There were eight (8) bedrooms designated for residents' use. Bedroom #1, bedroom #2, bedroom #3, bedroom #4, bedroom #5, and, bedroom #6 are for private used by residents were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Bedroom #7 and bedroom #8 is for staff used and is located in the second floor. Continue to LIC 809-C Bathrooms: Bathrooms: There are eight (8) bathroom designated for residents' use. The bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 115.1 degrees Fahrenheit for bathroom #1 located inside bedroom #1. Bathroom #2 is inside bedroom #2. Hot water temperature was measured at 113.4 degrees Fahrenheit. Bathroom #3 is inside bedroom #3. Hot water temperature was measured at 115.1 degrees Fahrenheit. Bathroom #4 is inside bedroom #4. Hot water temperature was measured at 116 degrees Fahrenheit. Bathroom #5 is inside bedroom #5. Hot water temperature was measured at 117.1 degrees Fahrenheit. Bathroom #6 is inside bedroom #6. Hot water temperature was measured at 119.2 degrees Fahrenheit. There was enough clean linen available in the cabinets in the hallway. Bathroom #7 and bathroom #8 is for staff, located beside the lock laundry room and in the second floor. Common Areas: LPA toured all common areas of the facility. These included the living room and dining area for residents. The common areas were properly furnished. Residents dining table fits enough for six (6). LPA observed common areas to be very clean and tidy. LPA observed the floors to be in very good condition. No obstructions and or tripping hazards throughout the facility. Furniture in common area was observed to be in good repair. There are no issues with Fire Clearance. Infection control: Facility mitigation plan to make sure licensee was following current infection control recommendations. LPA obtain a copy and reviewed the infection control plan during this visit. Surrounding Grounds: Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The facility does not have a swimming pool or bodies of water. The garage is attached and is used for storage. Laundry service: There is enough linen available to change weekly or more if need. LPAs found cleaning supplies are being stored in a locked cabinet in the laundry area and is located beside the dining table. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Office space is located on the 2nd floor. Records were checked for expired or missing certificates and clearances: LPA conducted a file review of staff for criminal record clearances and current First Aid. The administrator file was reviewed for current first aid, fingerprint clearance, administrator certificate, and HIV/AIDS and TB training. Continue to LIC 809-C Medications: are in a centrally stored and locked place in the kitchen, including over-the-counter medicines; medications are properly labeled and checked for expiration dates. Each centrally stored prescription and PRN medication has been logged in the medications log with proper documentation from the clients’ doctor. Proper medication dispensing instruction are followed and checked for contamination. First-aid has all proper items and is current. Resident records were reviewed for requirements and legibility: Planned activities are offered. LPA reviewed six (6) of the six (6) records and LPA found all files to be complete. Facility is within CA code of Regulations Title 22 or Health and Safety Code. No deficiencies were found, exit interview conducted, copy of report has been issued and discussed.the state’s words, verbatim · CDSS document, Feb 6, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA), Leslie Ngo-Castaneda conducted an unannounced Required 1-year inspection at this facility at approximately 3:20 PM LPA were greeted by staff, Coxia Carandang and was explained the reason for the visit. at 3:45 PM the administrator arrived and was disclosed the purpose of the visit. LPA conducted a tour of the physical plant at approximately 3:38 PM to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Common areas were observed for the ability to safely serve the needs residents. These included the kitchen, dining room area and living room. The common areas were checked for cleanliness and furniture was checked for functionality. Common areas observed to be furnished appropriately. LPA reviewed the food service areas, food storage and supply (perishable and nonperishable foods). The kitchen food supply was observed and sufficient for the six (6) residents currently residing there. Two (2) days of perishable food observed. The freezer is stocked with meats and frozen vegetables. Sharps are stored in locked kitchen drawer. The resident medications are locked in office cabinets near the kitchen. The medications were observed to be inaccessible to residents. There is one (1) fire extinguishes located in the kitchen. Fire extinguishers observed to be charged at 10.13.2024. Laundry room beside the kitchen and has an attached garage. The appliances observed to be functional. Due to time constraints this required annual will be completed at a later time. Exit interview conducted/Copy of report giventhe state’s words, verbatim · CDSS document, Jan 13, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. At 10:00 am Maria Elizabeth Sarmiento met with LPA, explained the reason for the visit, at 11:30 licensee Diana Kenez arrived. At 10:20 am, with the assistance of administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are operational that are located each bedroom, the hallway and kitchen. There are carbon monoxide detectors that functions properly. The fire extinguisher is in the kitchen. The charge date is 9/7/2023. During the visit the facility is at 73 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory residents; 6 may be bedridden and is cleared for 6 hospice waiver. Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked cabinet in the kitchen. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers. Cleaning supplies, pesticides or toxic cleaning supplies were stored and locked away in the kitchen. Bedrooms: There were eight (8) bedrooms designated for residents' use. Bedroom #1, bedroom #2, bedroom #3, bedroom #4, bedroom #5, and, bedroom #6 are for private used by residents were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Bedroom #7 and bedroom #8 is for staff used and is located in the second floor. Continue to LIC 809-C Bathrooms: There are eight (8) bathroom designated for residents' use. The bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 116.6 degrees Fahrenheit for bathroom #1 located inside bedroom #1. Bathroom #2 is inside bedroom #2. Hot water temperature was measured at 116.1 degrees Fahrenheit. Bathroom #3 is inside bedroom #3. Hot water temperature was measured at 116.4 degrees Fahrenheit. Bathroom #4 is inside bedroom #4. Hot water temperature was measured at 113.9 degrees Fahrenheit. Bathroom #5 is inside bedroom #5. Hot water temperature was measured at 117.1 degrees Fahrenheit. Bathroom #6 is inside bedroom #6. Hot water temperature was measured at 118.1 degrees Fahrenheit. There was enough clean linen available in the cabinets in the hallway. Bathroom #7 and bathroom #8 is for staff, located beside the lock laundry room and in the second floor. Common Areas: LPA toured all common areas of the facility. These included the living room and dining area for residents. The common areas were properly furnished. Residents dining table fits enough for six (6). LPA observed common areas to be very clean and tidy. LPA observed the floors to be in very good condition. No obstructions and or tripping hazards throughout the facility. Furniture in common area was observed to be in good repair. No fireplace in the facility. There are no issues with Fire Clearance. Infection control: Facility mitigation plan to make sure licensee was following current infection control recommendations. LPA obtain a copy and reviewed the infection control plan during this visit. Surrounding Grounds: Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The facility does not have a swimming pool or body of water. The garage detached and is used for storage. Laundry service: There is enough linen available to change weekly or more if need. Cleaning supplies are being stored in a locked cabinet in the laundry area and is located beside the dining area. Continue to LIC 809-C Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Office space is beside the den. Records were checked for expired or missing certificates and clearances: LPA conducted a file review of staff for criminal record clearances and current First Aid. The administrator file was reviewed for current first aid, fingerprint clearance, administrator certificate, and HIV/AIDS and TB training. Medications are in a centrally stored and locked place, including over-the-counter medicines; medications are properly labeled and checked for expiration dates. Each centrally stored prescription and PRN medication has been logged in the medications log with proper documentation from the clients’ doctor. Proper medication dispensing instruction are followed and checked for contamination. First-aid has all proper items and is current. Resident records were reviewed for requirements and legibility: LPA reviewed client’s files for current appraisal. Planned activities are offered. Facility is within CA code of Regulations Title 22 or Health and Safety Code. No deficiencies were found, exit interview conducted, copy of report has been issued and discussed.the state’s words, verbatim · CDSS document, Jan 23, 2024

Type of visit: Required - 1 Year

On 10/09/2023 Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. Upon arrival, LPA was greeted by staff and explained the reason for the visit. Shortly after, LPA met with back up Administrator Dianna Kenz. A tour of the physical plant was conducted at 10:15 AM. The facility has 2 stories. First floor is for residents and the second is for the live-in staff. Kitchen: The kitchen appeared clean and the appliances and fixtures functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Sharp objects were stored in locked drawers and cabinets. Medications are locked in the kitchen cabinet. Medications observed to be locked and inaccessible to clients. LPA observed fully stocked first aid kit in the kitchen drawer. Laundry Area: Appliances observed to be in good repair. Laundry room door was locked and thus laundry detergents were inaccessible to residents. LPA observed staff restroom room inside the laundry room. Temperature: Facility maintains a comfortable temperature of 78 degrees Fahrenheit. Surrounding Grounds: Entry/exits were observed to be locked. The outdoor area observed to have a covered shaded area for clients. There is no body of water in the facility. Smoke Alarms and Carbon Monoxide: The fire extinguisher is located in the kitchen, observed to be fully charged and was purchased on 09/07/23. Bathrooms: There were seven (7) bathrooms in the first floor of the facility. Six (6) bathrooms for residents use in private bedrooms. One (1) bathroom for staff located in the laundry room. All bathrooms were clean, properly supplied and had functional fixtures. Water temperatures were 115, 116.1,115.3,118.9,119.3 and 118.6 degrees Fahrenheit. LPA observed cleaning solutions in the bathroom cabinets. Staff immediately took all cleaning solution and locked them in the laundry room. Bedrooms: There were six (6) bedrooms designated for residents' use. All bedrooms are private and clean, properly furnished and had sufficient lighting. Common Areas: This includes the living room dining areas were appropriately furnished and lighting was adequate. The living room has a television and comfortable furniture. (Continue on 809C) The garage is currently being used for storage. Staff Rooms: Staff rooms are located upstairs. No medications are observed in the staff room Exit interview conducted and a copy of the report and appeal rights were provided. Deficiency was cited on 809D.the state’s words, verbatim · CDSS document, Oct 9, 2023