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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880740
Report Date: 12/20/2024
Date Signed: 12/20/2024 12:28:45 PM

Document Has Been Signed on 12/20/2024 12:28 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:GRACIOUS CARE HOMEFACILITY NUMBER:
331880740
ADMINISTRATOR/
DIRECTOR:		BRANDON MARQUEZ GUTIERREZFACILITY TYPE:
740
ADDRESS:12515 HUDSON RIVER DRIVETELEPHONE:
(951) 444-6651
CITY:EASTVALESTATE: CAZIP CODE:
91752
CAPACITY: 6CENSUS: 3DATE:
12/20/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Staff - Danielle Camila Romero HernandezTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to the facility to verify clearance of Plan of Correction from visit on 12/11/2024. LPA Rico met with caregiver Danielle Camila Romero Hernandez and was granted entry to the facility. During today's visit, Administrator Brandon Marquez Gurtierrez was not present at the facility. LPA Rico and staff Danielle Camila Romero Hernandez attempted to contact Administrator Brandon Marquez Gutierrez.

The following deficiencies were not cleared during the time of the visit:

The Licensee was cited on 12/12/2024 for 87509(d) Resident Records(d) . During today's visit, based on record review, observation and interview, LPA Rico observed that the Licensee did not have send LPA R2 records. The Plan of Correction was to send LPA Rico R2 records. Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for eight (8) days.

In addition, On 12/05/2025 the facility was cited for 87355 Criminal Record Clearance (e) for having S1 working without a criminal record clearance. On 12/11/2024 was cited for failure to correct The Plan of Correction. Today on 12/20/2024 LPA Rico observed S1 is still working at the facility without a criminal record clearance.

An exit interview was conducted and this report, LIC809 along with Civil Penalty Assessment pages, and Appeal Rights were reviewed and provided to caregiver Danielle Camila Romero Hernandez.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2024
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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