Inspection visit

Routine inspectionOctober 16, 2024

GRACIOUS CARE HOMELicense 33188074023 citations on this visit

23 citations recorded

Inspector’s narrative

What the inspector wrote

Licensing Program Analysts (LPAs) Mary Rico and Raquel Hernandez made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with caregiver Karim Morales and was granted entry to the facility. The facility is a (5) bedroom, (3), bathroom home and, with a kitchen/dining area, living room and attach garage. Licensed capacity is (6) current census (2). LPAs were accompanied by caregiver Karim Morales to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. The facility is equipped with operating carbon monoxide alarms and fire alarms. Posters such as personal rights, the CCL complaint poster, in the common area. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a variety of food available for clients. Dishes, cups, and utensils were also stored properly. Deficiencies that were found during facility tour: LPAs inspected residents’ bedrooms; R1 and R2 had mattresses, nightstands, storage space, but did not have chairs. During facility tour, LPAs observed two electric wires hanging off of the wall by residents’ bedrooms, this is fire hazard for residents in care. R1 and R2 did not have non-skid mats inside their bathroom tub. LPAs tested residents’ water; the temperature tested at 126 F. No cautions warning signs posted. In addition, during facility tour, LPAs observed the facility kitchen hallway, living area, resident’s hallways and (2) resident’s bedrooms did not have light installed nor lamps for appropriate lighting. LPAs inspected kitchen cabinets, (8) kitchen cabinets were dirty, with food crumbs and dirt. Furthermore, LPAs observed the window located by the dining area did not have a window screen install. LPAs and S1 tested facility phone, the phone was out of service. During facility tour, R1 and R2 bathroom was not free from incontinence odor. Next, LPAs tested exit monitor device for residents with dementia. The devices were turned off. The facility currently has (1) dementia residents, facility must always remain devices on. In addition, no activities were provided during inspection and the facility did not have activities listed for the residents. Lastly, LPA observed the facility did not have their First Aid Kit completed and did not have the American Red Cross Manual current edition. Delicacies that were found during record review: LPAs observed the facility did not have their Plan of Operation in their facility file and no Disaster Plan 610. In addition, R1 did not have their hospice care plan in file, and R2 did not have their annual medical assessment which is required for dementia resident. Furthermore, R1 did not have (1) of their medication listed on their MAR and did not have their PRN documented with the time, date, and resident response. Lastly, during criminal record clearance check, LPAs observed S1 is not associated to the facility. The licensee was advised to submit transfer request. Deficiencies that were found during care & supervision: The facility does not have sufficient staff coverage, based on the LIC500 the staff members that were scheduled were not present. During staff interview, S1 stated they will be working over 24 hours. During facility annual inspection, the facility did not have a designated staff present, house manager or Administrator present. Moving forward the licensee shall ensure the facility has designated staff present or Administrator present for 24 hours as stated in Tittle 22 Regulations. Based on observations today, a civil penalty in the amount of $500.00 dollars will be issued for not transferring S1 criminal record clearance. The facility will be issued (11) Type A deficiencies and (12) Type B deficiencies per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed to Licensee Sandy Zhao on the phone and was provided to caregiver Karim Ibarra Morales along with a copy of LIC809D, LIC421BG, and the appeal rights.

Citations

23 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.

1569.618(b)Type A
Based on observation and interview , the licensee did not comply with the section cited above by not having a designated substitiute present which poses an immediate health, safety or personal rights risk to persons in care.
1569.618(c)Type A
Based on observation interview record review, the licensee did not comply with the section cited above. S1 stated they work all day, based on LIC500 staff schedule were not present which poses an immediate health, safety or personal rights risk to persons in care.
1569.618(c)(3)Type A
Based on record review, the licensee did not comply with the section cited above, S1 did not have a CPR card which poses an immediate health, safety or personal rights risk to persons in care.
1569.618(c)(4)Type B
Based on observation, the licensee did not comply with the section cited above by having two electric wires hanging off facility wall by residents bedroom which poses/posed a potential health, safety or personal rights risk to persons in care.
1569.695(a)Type B
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
87208(a)Type B
Based on record review , the licensee did not comply with the section cited above by not having the plan of operation in the faciity file which poses/posed a potential health, safety or personal rights risk to persons in care.
87219(a)Type B
Based on record review, the licensee did not comply with the section cited above the facility did not have activities for residents,and during facility inspection no activities were provided which poses/posed a potential health, safety or personal rights risk to persons in care.
87303(a)Type A
Based on observation, the licensee did not comply with the section cited above by having (8) kitchen cabins dirty which poses an immediate health, safety or personal rights risk to persons in care.
87303(c)Type B
Based on observation, the licensee did not comply with the section cited above by not having a window screen by the dining area which poses/posed a potential health, safety or personal rights risk to persons in care.
87303(d)Type A
Based on observation and interview , the licensee did not comply with the section cited above by not having lights working in the kitchen hallway, living room, and resident's hallway which poses an immediate health, safety or personal rights risk to persons in care.
87303(e)(3)Type A
Based on observation , the licensee did not comply with the section cited above . The water tested at 126 F and did not have warning signs which poses an immediate health, safety or personal rights risk to persons in care.
87303(e)(5)Type B
Based on observation the licensee did not comply with the section cited above by not having non-skid mats for R1 and R1 bathroom which poses/posed a potential health, safety or personal rights risk to persons in care.
87307(a)(3)(B)Type B
Based on observation , the licensee did not comply with the section cited above by not having a chair for R1 and R2 which poses/posed a potential health, safety or personal rights risk to persons in care.
87311Type B
Based on observation, the licensee did not comply with the section cited above, S1 and LPA Rico tested the facility phone, the line was out of services which poses/posed a potential health, safety or personal rights risk to persons in care.
87355(e)(3)Type A
Based on record S1 did not have a request for their criminal record clearance to be transfer, the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care.
87465(a)(8)Type B
Based on record review , the licensee did not comply with the section cited above by not having a complete kit approved by American Red Cross which poses/posed a potential health, safety or personal rights risk to persons in care.
87465(a)(8)(A)Type B
Based on record review, the licensee did not comply with the section cited above by a current edition first aid manual approved by the American Red Cross which poses/posed a potential health, safety or personal rights risk to persons in care.
87465(d)(3)Type A
Based on record review, the licensee did not comply with the section cited above by not having R1 PRN medication record of the time, date and resident response which poses an immediate health, safety or personal rights risk to persons in care.
87465(e)Type A
Based on record review , the licensee did not comply with the section cited above by not having R1 medication listed on MAR file which poses an immediate health, safety or personal rights risk to persons in care.
87625(b)(3)Type B
Based on observation, the licensee did not comply with the section cited above by not having R1 and R2 bathroom free from incontient odor which poses/posed a potential health, safety or personal rights risk to persons in care.
87633(b)Type B
Based on record review, the licensee did not comply with the section cited above which poses/posed by not having R1 hospice care plan potential health, safety or personal rights risk to persons in care.
87705(c)(5)Type A
Based onrecord review , the licensee did not comply with the section cited above by R2 not having their annual medical assessment, last annual was dated of the year 2021, which poses an immediate health, safety or personal rights risk to persons in care.
87705(j)Type A
Based on observation, the licensee did not comply with the section cited above the facility did not have the alert devices on which poses an immediate health, safety or personal rights risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the October 16, 2024 inspection of GRACIOUS CARE HOME?

This was a inspection inspection of GRACIOUS CARE HOME on October 16, 2024. 23 citations were issued: 11 Type A (serious) and 12 Type B.

Were any citations issued to GRACIOUS CARE HOME on October 16, 2024?

Yes, 23 citations were issued (11 Type A, 12 Type B). The first citation was for: "Based on observation and interview , the licensee did not comply with the section cited above by not having a designated..."

What type of inspection was this?

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

SourceView on CCLD View original report

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Data from CCLD public records. Last updated May 25, 2026. If you believe any information is inaccurate, report it here.

Routine inspection·October 16, 2024