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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920243
Report Date: 02/03/2025
Date Signed: 02/03/2025 10:18:13 AM

Document Has Been Signed on 02/03/2025 10:18 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ALL GRACE SENIOR CARE LLCFACILITY NUMBER:
315920243
ADMINISTRATOR/
DIRECTOR:
MARTIN, RAMSEY LFACILITY TYPE:
740
ADDRESS:208 WALPOLE COURTTELEPHONE:
(916) 742-6496
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY: 6CENSUS: 0DATE:
02/03/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Applicant- Ramsey MartinTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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On 02/03/25, Licensing Program Analyst (LPA) Talwinder Bains met with applicant, Ramsey Martin, to conduct an announced Pre- Licensing visit. Facility has no residents during today's visit. Applicant holds a current administrator certificate ( # 7009626740 with expiration date 10/13/2026).

LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. Facility inspection is done for these areas but not limited to four (4) residents bedrooms , one (1) staff room, two (2) bathrooms, common area , kitchen, laundry room, outside area and laundry area . Bathrooms and bedrooms were in sanitary condition and properly maintained. LPA checked the kitchen area for the ability to prepare and store food. Knives and Sharp objects found to be locked . LPA observed cleaning products and other toxins to be locked away. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detectors at the care home are operational. Fire extinguisher is ready for emergency use. Facility was approved for six (6) non-ambulatory residents, as indicated by fire department , dated -10/22/24. Water temperature reading was within compliance. All required postings were observed. Facility shall notify Department once first consumer will admit to the facility.

Component III for RCFE was completed during this visit.

LPA will forward findings to the Centralized Application Bureau (CAB) that facility met all the pre-licensing components.

Applicant has satisfied all requirements in accordance to Title 22, California Code of Regulations on today's pre-licensing inspection. A copy of this report was provided to the facility. Exit interview conducted.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2025
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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