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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006416
Report Date: 03/07/2025
Date Signed: 03/07/2025 03:42:03 PM

Document Has Been Signed on 03/07/2025 03:42 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ABUNDANT GRACE CARE VILLAFACILITY NUMBER:
306006416
ADMINISTRATOR/
DIRECTOR:
DOMPREH-MENSAH, THERESAFACILITY TYPE:
740
ADDRESS:9672 COLONY STREETTELEPHONE:
(657) 201-3142
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 0DATE:
03/07/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:44 PM
MET WITH:Thersa Dompreh-Mensah LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) William Vanegas made and unannounced inspection for the purposes of completing an annual inspection. Upon arrival LPA Vanegas was greeted and granted entry to the facility and explained the purpose of the inspection. LPA Vanegas set up equipment and began a tour of the facility and observed the following.

Currently there are no residents in care. This is a one storied home with four bedrooms, one of which is a staff room, and three of which are resident rooms. There are two bathrooms one private bathroom and one shared bathroom. LPA Vanegas observed kitchen area to be clean and free of mildew and debris, there is a dishwasher, refrigerator, microwave, and gas stove that are in good repair, and tested operational. Resident bathrooms were observed to have functional toilets, and sinks. Along with all required furnishings, water tested between 135.3 and 136.2 Licensee was advised to lower water temperature prior to residents moving in.All bed rooms are ready for resident use, and have the required furnishings such as a lamp, chair, bed, and clean linens in good repair; meaning no strains or tears. Rooms are large enough to walk about freely, and no obstructions are blocking entry ways.
LPA Vanegas observed an additional back house that is unoccupied, and is in the process of becoming licensed as well, this is a back house that has a different address, and is in good repair and vacant.LPA Vanegas observed outside of the facility to be clean and spacious, no obstructions are blocking emergency exit routes. Backyard is big enough to participate in outdoor activities upon resident request. LPA Vanegas observed all proper postings to be displayed along entry way of the facility. LPA Vanegas observed first aid kit to have all required items such as adhesive tape, scissors, tweezers, a thermometer, and a first aid manual. LPA Vanegas observed fire extinguishers to be up to date, and fully charged. LPA Vanegas observed smoke and carbon monoxide detectors to be in good repair and operational. Based on observations made during todays inspection no deficiencies will be cited per title 22 chapter 8 division 6 of the California Code of Regulations. An exit interview was completed with Licensee Theresa Dompreh and a copy of this report was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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