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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006551
Report Date: 09/10/2024
Date Signed: 09/10/2024 01:21:44 PM

Document Has Been Signed on 09/10/2024 01:21 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 #2FACILITY NUMBER:
306006551
ADMINISTRATOR/
DIRECTOR:		GHAHYASI, JENIFERFACILITY TYPE:
740
ADDRESS:140 W. DUNTONTELEPHONE:
(714) 396-4321
CITY:ORANGESTATE: CAZIP CODE:
92865
CAPACITY: 6CENSUS: 0DATE:
09/10/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Glenn Navarro, ManagerTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Rose Ruppert made an announced visit to the facility for the purpose of conducting a pre-licensing inspection follow-up from September 6, 2024. LPA met with Manager, Glenn Navarro at 1pm.

LPA toured the facility and observed six bedrooms and all have the required furnishings. One bedroom has a full bed, five bedrooms have a twin bed and all beds have mattresses and linens. The hot water temperature was measured in two of two resident bathrooms at 108.4 and 108.6 degrees Fahrenheit. The fireplace in the living area and in the back bedroom both have screens. A First Aid manual book was purchased to accompany the First Aid Kit and a weekly menu was observed on the refrigerator.

Manager was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. An exit interview was conducted and a copy of this report was provided to the Manager.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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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