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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006542
Report Date: 10/09/2024
Date Signed: 10/09/2024 09:04:53 AM

Document Has Been Signed on 10/09/2024 09:04 AM - 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:GRACE SENIOR SOLUTIONS #1FACILITY NUMBER:
306006542
ADMINISTRATOR/
DIRECTOR:		GHAHYASI, JENNIFERFACILITY TYPE:
740
ADDRESS:2431 E ORANGEVIEWTELEPHONE:
(714) 396-4321
CITY:ORANGESTATE: CAZIP CODE:
92867
CAPACITY: 6CENSUS: 5DATE:
10/09/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Glenn Navarro - House ManagerTIME VISIT/
INSPECTION COMPLETED:
09:15 AM
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Licensing Program Analyst (LPA) Jerome Haley made an announced visit to conduct the second pre-licensing inspection. LPA Haley was greeted and granted entry by House Manager Glenn Navarro. LPA Haley explained the reason for the visit upon entry.

During a tour of the facility, LPA Haley observed that the following items have been corrected.

1. The stove has been replaced. The applicant bought a brand new stove. All burners on the new gas stove are operational. 2. All the bulk items that were on the side of the facility have been removed. The side of the facility is clan and organized.



All items have been corrected. No new deficiencies were observed, and no additional corrections are needed. The facility is ready for licensure.

Component III was waived, as the applicant operates other licensed facilities.

An exit interview was conducted, and a copy of this report was provided.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2024
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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