Seniors With Grace Care Home

Type of visit: Case Management - Other

On 5/8/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility for the purpose of conducting a closure visit initiated by the Licensee. LPA Calandra was greeted by Grace Manuel and Noel Manuel, Administrators/Licensees and explained the purpose of the visit. LPA conducted a walk-through of the facility, inspected all rooms and common spaces. There are currently no residents living in the facility and the last resident moved out on 4/17/2025. LPA was provided with a list of all residents and relocation sites and given updates throughout the months leading up to the final closure. During today's inspection, LPA Calandra found no evidence to suggest that there are any residents in care. Administrator stated that residents have taken selected personal belongings and furnishings for transfer to their new facilities. The facility files for both residents and staff will be kept in storage for 3 years. The Licensee initiated this facility closure and submitted a written statement to Community Care Licensing (CCL) on 3/18/2025, requesting to close this facility. All residents were found to be safely relocated. Closure inspection of this facility has been completed. Facility will be surrendering the license to LPA Calandra and will be sending it directly to the CCLD San Bruno Regional Office. The Department will be moving forward with the closure process. No deficiencies were cited during today's visit. An exit interview was conducted. This report was reviewed with Noel and Grace Manuel, Licensees/Administrators and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, May 8, 2025

Type of visit: Required - 1 Year

On 3/21/2025, Licensing Program Analyst(LPA) John Calandra and Licensing Program Manager(LPM) Andrea Medlin arrived at the facility to conduct the Annual 1-year required inspection at 9:30AM. LPA Calandra and LPM Medlin were greeted by Joewel Santos, Caregiver/House Manager and explained the purpose of the visit. LPA spoke to Licensee/Administrator Grace Manuel over the phone and was informed she would not be able to join the visit. LPA Calandra and LPM Medlin toured the physical plant. This is a 1-story building with 4 bedrooms and 3 bathrooms(2 for residents and 1 for staff), a living room, dining room, kitchen, and outdoor space/backyard. All bedrooms had the required furniture and sufficient lighting. No accessible bodies of water or hazards were observed in hallways or the backyard. The facility's fire alarms and Carbon Monoxide detector were observed to be in working order. The facility's first aid kit was observed to have all required items. The facility had the required 7 days of non perishables and 2 days of perishables on site. No food was expired. The facility was maintained at a comfortable temperature of 72 degrees Fahrenheit. The facility's hot water was measured between the required 105-120 degrees Fahrenheit. The facility's fire extinguishers were last serviced on 9/16/2024. All sharp objects, poisons, and detergents were observed to be locked and in-accessible to persons in care. LPA and LPM reviewed 6 resident records and 5 staff files. All were observed to be complete. A review of Centrally stored medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. LPA and LPM requested a copy of the updated LIC 500 (Personnel Summary Report) by 3/28/2025. LPA and LPM received a copy of the Administrator's Certificate. Deficiencies are cited under the California Code of Regulations, Title 22. Failure to correct the deficiencies by the due date may result in civil penalties. An exit interview was conducted. This report was reviewed with Joewel Santos, Caregiver/House Manager and a copy of the report along with Appeal Rights left at the facility.the state’s words, verbatim · CDSS document, Mar 21, 2025

Type of visit: Required - 1 Year

On this day, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced required 1 year annual inspection visit. LPA met with licensee/administrator Grace Maneul and explained the purpose of today's visit. Prior to entry LPA observed that the exterior of the facility is undergoing renovations/painting. No walkways are obstructed prior to entry. No renovations are taking place inside the facility that may affect residents in care. LPA was allowed entry to the facility. This is a single level facility and is licensed to serve 6 residents all of whom may be non-ambulatory. Facility has a hospice waiver on file for 4 residents. There are 2 residents on hospice during today's visit. Annual Fees are current. The physical plant is toured inside and outside to ensure the safety of the residents. During today's visit LPA observed all residents, one of which was still sleeping in bed, and the rest are in common areas. LPA observed the facility kitchen which is located adjacent to the dining room. Knives are stored within the kitchen in a cabinet adjacent to the sink. Medication cabinet is observed as lockable adjacent to the stove and above the counter. It is unlocked at time of inspection due to staff distributing medications and preparing. Perishable and non-perishable food items are observed as in place in the refrigerator in the kitchen. Additional refrigerators are observed and contain additional food items in the garage area. Resident medications are in place and current. The first aid kit is maintained and is complete with required items as observed in an emergency back pack. Continued on LIC809C... Page 2 - LIC809 LPA observed fire alarm pulls throughout the facility, 3 fire extinguishers are observed with inspection dates of 09/19/2023, smoke detector/carbon monoxide detectors are in place through out resident rooms and main hallway, and central heating in the facility as in place. PPE supply is in place. Laundry room is also observed and is full operational and located near the kitchen area near a resident room. linen closet is observed as in place and per the licensee/administrator the residents also have extra linens in their rooms. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Resident rooms were observed and all contained the required furniture as outlined in regulations. Water temperature is tested at 105F in common bathroom near the living room where a large shower is in place and shower chair for resident use. Bathroom is clean and operational. The facility does not handle resident money. Administrator certificate for Grace Manuel is observed as current expiring 10/16/2024. Back up administrator certificate is observed for Noel Manuel as expiring 10/16/2024. LPA reviewed associations with the licensee and she says it is current to who is present on this day but will disassociate those who are no longer working at the facility. 2 of 6 resident files are reviewed and are current. 3 staff files are reviewed and are current. Staff training is on file and current. The following updated forms are being requested to be received by 05/01/2024: • LIC610E Emergency Disaster Plan • LIC 308 Designation of Administrative Responsibility • LIC 500 Personnel Report • Updated administrator certificate • LIC9020 Client Roster • Certificate of Liability Insurance • Control of property Per the California Code of Regulations, Title 22, Division 6, Chapter 6, there are no deficiencies cited on this day. Report is reviewed with licensee/administrator Grace Manuel.the state’s words, verbatim · CDSS document, Apr 24, 2024