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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006542
Report Date: 12/23/2024
Date Signed: 12/23/2024 03:19:53 PM

Document Has Been Signed on 12/23/2024 03:19 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: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: 6DATE:
12/23/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:51 PM
MET WITH:Jon ArtjiusTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Samer Haddadin is conducting this unannounced visit for the purpose of conducting a health and safety . LPA arrived at the facility was greeted and granted entry by staff member Jonathan Artjiu and explained the reason of the visit.
During the visit LPA toured the interior and exterior of the facility. LPA observed that the facility was equipped with sufficient hand hygiene, cleaning, and disinfecting supplies and that toxic chemicals, cleaning solutions and disinfectants were locked and secured

Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.


This report was reviewed with the facility staff and a copy of this report was provided.

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SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE: DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/23/2024
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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