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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306090049
Report Date: 08/28/2024
Date Signed: 08/28/2024 02:52:04 PM

Document Has Been Signed on 08/28/2024 02:52 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:GRACE RETIREMENT VILLAGEFACILITY NUMBER:
306090049
ADMINISTRATOR/
DIRECTOR:		MICHELLE SONGFACILITY TYPE:
740
ADDRESS:1100 E. WHITTIER BLVD.TELEPHONE:
(562) 694-6515
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY: 340CENSUS: 115DATE:
08/28/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:34 PM
MET WITH:Erik DoanTIME VISIT/
INSPECTION COMPLETED:
02:50 PM
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On today’s date, an Office Conference was held at the Orange County Adult and Senior Care Regional Office (Office) in Orange, California per request of the Licensee Erik Doan. Regional Manager (RM) Marina Stanic appeared via Microsoft Teams and Licensing Program Analyst (LPA) Sean Haddad and Licensee Doan were present at the Office.

Licensee Doan had requested the Office Conference to discuss his concerns with facility operations.

During the Office Conference, the following items were discussed:
• Licensee Doan shared that he is concerned about the facility’s compliance issues as evidenced by recent citations and that they have had trouble handling the facility as it is their first assisted living facility, they are not able to be present at the facility 24/7 to oversee their administrators, and that they have language and cultural barriers with residents and staff.
• Licensee Doan requested a copy of the accusation against their predecessor facility, Bok Senior Hotel (306005182). LPA provided Licensee Doan with a public copy of the legal action against Bok Senior Hotel.
• Licensee Doan expressed concerns regarding the interactions with investigative staff and requested the contact information of the Investigations Branch supervisor. LPA provided Licensee Doan the requested contact information.
• RM and LPA answered Licensee Doan’s questions regarding the process of applications and changes of ownership and also the Department’s tools for bringing any facility into compliance.

An exit interview was conducted and a copy of this report was discussed with and provided to Licensee Doan.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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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