House of Grace for Senior Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced, required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Caregivers Urdaneta Balila and Geraldine Penola. Administrator Helenita Penola arrived later during the visit. The facility's license shows a maximum capacity of six (6) non-ambulatory residents. Additionally, the facility has a hospice waiver for two (2). During today’s inspection there were six (6) residents in care. LPA and Administrator Penola toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to clients were all compliant: Common bathroom sink 1 was 108F and common bathroom sink 2 was 109F. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. Knives were locked and inaccessible to residents in care. [Continued on LIC 809-C] [Continued from LIC 809] No toxic chemicals or poisons were accessible to clients. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Administrator Penola, no firearms or ammunition are kept at the facility. Smoke and carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were present and purchased within the last 12 months. First aid kit was complete and readily accessible. Last staff emergency drill conducted was on 9/5/25 for the topic of fires and mass casualty disasters. Required licensing postings were observed in visible areas of the facility. LPA observed residents to be attended to timely and treated with respect. LPA observed a meal be prepared and served to residents as well as assistance with feeding as needed. LPA interviewed one (1) staff and two (2) outside source visitors and interviews did not reveal any licensing or regulatory concerns. LPA reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. LPA noted that one (1) staff member (identified as S1) was included on the staff roster but did not have a background clearance on file. Another staff member (Identified as S2) had an Excluded determination on their background check, and thus may not be present or work at any licensed facility. Two Type A Deficiencies cited per California Code of Regulations, Title 22, Division 6 on the attached LIC 809-D. In addition, a Civil Penalty for each of the two Type A violations are being assessed for Zero Tolerance Violations regarding Criminal Record Clearances and are noted on the two (2) attached LIC 421BG forms in the combined amount of $1,000.00. LPA ensured S2 was removed from the property and informed the licensee that S1 may not be present at the facility until S1 receives an eligible background clearance from the California Department of Social Services (CDSS). In regards to S2, LPA issued a Decision and Order letter to the Licensee and provided consultation for next possible steps. Two (2) deficiencies were cited during the inspection. An exit interview was conducted with Administrator Penola to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Oct 17, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alyssa Ramirez conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with Caregiver Julie Penola. Administrator Helenita Penola later arrived to meet with LPA. According to the facility’s license, the facility is licensed for six (6) non-ambulatory residents. Facilities current census is four (4). LPA, accompanied by staff, toured the interior and exterior of the facility, and inspected resident bedrooms. Facility was clean, sanitary, and in good repair. Resident bedrooms contained the required furnishings. Extra linens and hygiene supplies were present. Hot water temperature was in compliance. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water on premises. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher and first aid kit present. Required licensing postings were observed in visible areas of the facility. LPA interviewed staff/residents and reviewed multiple staff/resident files. The files which LPA reviewed contained all required documents. No deficiencies were cited during today's annual inspection. An exit interview was conducted with Penola to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Sep 17, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA identified himself and discussed the purpose of the visit with Administrator Helenita Penola. According to the facility’s license, the facility has a maximum capacity of six (6) residents, of whom six (6) can be non-ambulatory. Zero (0) may be bedridden and a hospice waiver approved for two (2) residents. During today’s inspection there were six (6) residents present. LPA, accompanied by Administrator toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water on the premises. Per Administrator, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. [CONTINUED ON LIC 809-C] LPA interviewed staff, resident and reviewed multiple staff and resident records/files. LPA interviews did not raise any licensing concerns. The files which LPA reviewed contained required documents. Confidential records were stored in locked areas. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Helenita Penola to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Oct 31, 2023