House of Grace 4

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced annual inspection visit on 12/18/2025 and was greeted by Caregiver Aries Mendoza. LPA Ramirez identified herself and explained the purpose of the visit. The facility is located on a residential street and is a single-story dwelling. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Physical Plant and Environment safety: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be inaccessible to residents. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected three (3) resident rooms. Facility maintains a staff room. All resident bedrooms contained required furniture, linens and lighting. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. LPA Ramirez observed grab bars near toilets and inside shower. LPA Ramirez observed no-slip coating in showers. LPA Ramirez observed seated shower chairs in bathrooms. Food Service: LPA Ramirez observed sufficient supply of nonperishables for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean and within temperatures of 0-degree F (-17.7 degree C), and refrigerators with maximum temperature of 40-degree F. (4 degree C). See 809-C Planned Activities: LPA Ramirez observed board games, magazines, and other activities for residents. Residents Rights-Information: LPA Ramirez observed the following postings in common areas throughout the facility: Complaint Poster (PUB 475), personal rights, and nondiscrimination notice. LPA Ramirez observed facility land line. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. Last documented emergency drills were conducted on 11/01/2025. LPA Ramirez observed facility sketches with exits and emergency exits routes throughout various locations of the facility. LPA Ramirez observed emergency food supply located in pantry. Residents with Special Needs: No large bodies of water were observed LPA Ramirez observed signs posted indicating “No smoking - Oxygen in Use” in various locations of the facility. LPA Ramirez observed several oxygen tanks in resident rooms secured in stands. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. Auditory devices were observed to be in working order. Health Related Services/Incidental Medical Services: The medications are centrally stored in the medication closet and in bubble packs and/or original containers. LPA Ramirez observed Centrally Stored Medication and Destruction Record. The facility provides incidental medical services. Staffing: Administrator Certificate for Michelle Aguirre 08/29/2026. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Personnel Records Training: Staff files are maintained at the facility. LPA Ramirez observed required annual training, CPR and First Aid for three (3) out of the three (3) personnel record reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for three (3) out of the three (3) personnel record reviewed. Infection Control: Staff are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place. SEE 809-C Operational Requirements: The fire clearance is approved for six (6) non ambulatory residents over the age of 59 years old. This facility may retain no more than four (4) hospice residents. There were four (4) residents on hospice during time of inspection. Resident Records/Incident Reports: LPA reviewed resident records for six (6) residents in care. Resident records are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, Resident Rights were observed. No deficiencies were observed during this visit. Exit interview conducted. A copy of this report was provided via email.the state’s words, verbatim · CDSS document, Dec 18, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cynthia Chan conducted an annual inspection on 9/17/24. LPA arrived unannounced and met with Staff, Alvin Arbis. The purpose for the visit was explained. Administrator, Michelle Aguirre, arrived shortly after to assist with the visit. The facility is licensed for 6 non-ambulatory residents, ages 60 and over. There is a hospice waiver for 4 residents. LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tools. The facility consists of 3 resident shared bedrooms, 1 staff room, 2 1/2 bathrooms, living room, dining room, kitchen, laundry area, and detached garage. There are no swimming pool or bodies of water on the premises. The bedrooms have the required furniture, storage space, and sufficient lighting. The spacious backyard has a shaded area for residents. There is an operable carbon monoxide detector and smoke detectors throughout the home. Knives and cleaning supplies are locked. There is sufficient space to accommodate indoor and outdoor activities. Facility has 2 day perishable and at least a week of non-perishable food. There are currently 6 residents residing at the facility. LPA reviewed all the residents files and the required documents are maintained in their files. Medications are centrally stored and inaccessible to residents. There were no discrepancies found for the meds. The personal rights, complaint and ombudsman posters are posted in a prominent area. LPA reviewed 3 staff files. The administrator's (Michelle Aguirre) certificate expired on 8/28/24. Per the Administrator, she is still in the process of completing the courses to renew the certificate. Staff have current CPR & First Aid certificates. LPA provided technical advisories on annual training for staff. Facility has the Emergency Disaster Plan posted. LPA issued a technical advisory on emergency drills in order to satisfy the requirement. A deficiency was issued today. An exit interview was held and a copy of this report and technical advisory notes were given to the staff.the state’s words, verbatim · CDSS document, Sep 17, 2024

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Alberto Lopez made a subsequent announced visit and was greeted by Licensee/Administrator Michelle Aguirre. LPA explained the purpose of the visit. The purpose of the visit is to verify Licensee compliance for the following: 1) Ombudsman poster 2) Labor law poster 3) Water temperature compliance. 4) Grab bar repair. LPA verified that Licensee corrected the following: 1) Ombudsman poster witnessed by LPA during visit. 3) Water temperature compliance. Verified that water temperature range measured between 108.0 and 116.2 degrees F which is within range of 105.0 - 120 degrees F. 4) Grab bar repair. LPA verified repair of grab bar. The Labor law poster (2) was not posted at facility and Licensee stated that it is not required. LPA is referring the application back to CAB to make the decision if labor law poster is required and approve Licensee.the state’s words, verbatim · CDSS document, Nov 17, 2023

The state marks this report as 5 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Alberto Lopez made an announced visit and was greeted by Licensee/Administrator Michelle Aguirre and Administrator Rebecca Sinclair for the purpose of conducting a pre-licensing and Component 3 visit. Tour was conducted and the following was observed; medications were in a locked area, physical plant is in good repair, smoke detectors operate properly, fire extinguishers are properly charged, cleaning solutions and sharps are locked, building and grounds are free from hazards, passageways, and doors are not blocked or obstructed, signal system is operable, beds have the required linen/supplies, mattresses and bedsprings are in good repair, resident's rooms have the appropriate furniture (one chair, night stand, adequate lighting for each resident, adequate closet and drawer space), bedrooms are large enough to allow for easy passage between and comfortable for usage of beds and other required items of furniture and any assistant devices such as walkers. Water temperature was not within normal range (105 F to 120 F) degrees Fahrenheit. Refrigerator, stove, telephone, sinks, tubs, toilets and showers operate properly. There are enough bath towels, hand towels and wash cloths for all clients. Enough personal hygiene supplies are available for residents. There are enough linens available to permit weekly changes to ensure use of clean linens at all times by residents. All bathrooms were equipped with grab bars, (one grab bar is loose and needs to be repaired) and non-skid mats. Pantry's cupboards, freezers, stoves, microwaves, refrigerator, and counters are clean. Garbage cans have tight fitting covers. Two day supply of perishables available on day 1 of move in of residents, seven day supply of non-perishable available. The facility has sufficient dining tables and chairs. Pesticides and other toxic substances are stored and locked away from food supply. Resident records are inaccessible to unauthorized persons. Emergency disaster plan, personal rights and complaint procedures are posted with exception of Ombudsman poster. First Aid Kit is fully stocked. There is adequate seating in common area for licensed capacity. No resident bedrooms are used as public or general passageway to another room, bath or toilet. Night lights are maintained in the hallway and passages to non-private bathrooms. Post labor information as required by law is not posted. Notices of planned activities are posted in a central facility location readily accessible to clients, relatives and representatives of placement and referral agencies. Activity supplies, available. Privacy is provided in all toilets, bath, and shower areas. Facility has a theft and loss policy posted. Emergency exiting plans and telephone numbers are posted. Procedures to file confidential complaints are posted; a copy of resident rights or instructions on how to obtain a copy of the rights is provided to residents. There is a working telephone. Carbon monoxide detector is operable. The following rooms were inspected: #01, 02, 03, 04. Physical plant will meet Title 22 Regulations when grab bar in restroom is repaired, ombudsman labor poster is posted, and water temperature is adjusted to be in compliance with department regulations and measure in the range of 105-120 degrees F. Licensee will summit proof of Liability Insurance once obtained. Exit interview conducted and copies provided.the state’s words, verbatim · CDSS document, Nov 3, 2023

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.