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Inspection visit

Follow-up on corrections

GRACE RETIREMENT VILLAGELicense 3060900492 citations on this visit
2 citations recorded

Inspector’s narrative

What the inspector wrote

This unannounced Case Management – Deficiencies inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of issuing citations for deficiencies observed during the investigation into Complaint Control No. 22-AS-20240624114306. LPA met with Administrator (AD) Michelle Song and explained the reason for today’s inspection. During the course of the investigation, Department staff inspected the facility, interviewed staff, and obtained and reviewed copies of the resident roster and staff roster. Department staff requested information on facility staff who worked at the facility between April 8 and April 12, 2024. On October 22, 2024, Licensee Erik Doan identified Staff #4 (S4), Staff #5 (S5), Staff #6 (S6), and Staff #7 (S7) by first name only, stated they had worked at the facility during this time period, but could not provide any additional identifying information because they no longer work at the facility, and did not maintain staff files for these staff as required. Per Guardian records, S4, S5, and S7 were not background cleared while working at the facility. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. Immediate civil penalties are being assessed. See LIC421BG. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.

Citations

6 citations recorded*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

  • 87211(a)(1)Type B

    87211 Reporting Requirements (a) … (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days … shall include the resident's name, age, sex and date of admission; date and nature of event… This requirement was not met as evidenced by: Based on interviews and documents, the licensee did not provide a written report of R1’s fall to the OCRO or R1’s responsible party, which poses a potential health risk to persons in care.

  • 87465(a)(1)Type A

    87465 Incidental Medical and Dental Care (a)… (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by: Based on interviews and documents, the licensee did not notify R1’s doctor or obtain a medical assessment after R1’s fall and did not obtain medical care for R1 in response to R1’s change of condition, which poses an immediate health risk to persons in care. CIVIL PENALTY ASSESSED.

  • 87355(e)(1)Type A

    87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance… This requirement was not met as evidenced by: Based on admission and documents, the licensee did not ensure S4, S5, and S7 were background cleared prior to working at the facility, which poses an immediate safety risk to persons in case. CIVIL PENALTY ASSESSED.

  • 87412(a)Type B

    87412 Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee... This requirement was not met as evidenced by: Based on interviews and documents, the licensee did not maintain personnel records for 4 staff, which poses a potential safety risk to persons in care.

  • 87465(a)(4)Type A

    87465 Incidental Medical and Dental Care. (a) … (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by Based on documents and interviews, the licensee did not ensure R1 received assistance with medications by not giving them their prescribed medications for multiple days, which poses an immediate health risk to persons in care.

  • 87465(a)(5)(A)Type A

    87465 Incidental Medical and Dental Care. (a) … (5) ... Assistance with self-administered medications shall be limited to the following: (A) Medications usually prescribed for self-administration which have been authorized by the person's physician. This requirement was not met as evidenced by: Based on documents and interviews, the licensee did not ensure R1 received assistance with medications by offering R1 oxygen and giving R1 Tylenol which were not prescribed, which poses an immediate health risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the March 26, 2025 inspection of GRACE RETIREMENT VILLAGE?

This was a other inspection of GRACE RETIREMENT VILLAGE on March 26, 2025. 2 citations were issued: 1 Type A (serious) and 1 Type B.

Were any citations issued to GRACE RETIREMENT VILLAGE on March 26, 2025?

Yes, 2 citations were issued (1 Type A, 1 Type B). The first citation was for: "87211 Reporting Requirements (a) … (1) A written report shall be submitted to the licensing agency and to the person res..."

What type of inspection was this?

This was a other inspection. other inspections are conducted by CCLD as part of their licensing oversight.

SourceView on CCLDView original report

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Data from CCLD public records. Last updated . If you believe any information is inaccurate, report it here.