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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700771
Report Date: 09/04/2024
Date Signed: 09/04/2024 03:39:53 PM

Document Has Been Signed on 09/04/2024 03:39 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:GRACE CARE HOMEFACILITY NUMBER:
342700771
ADMINISTRATOR/
DIRECTOR:
PALAFOX LAPID, GRACIAFACILITY TYPE:
740
ADDRESS:7708 RUDYARD CIRCLETELEPHONE:
(916) 692-8063
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY: 4CENSUS: 3DATE:
09/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Administrator- Gracia Lapid TIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On 09/04/24 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a Required -1 year inspection utilizing the care tool. LPA met with Administrator Gracia Lapid and explained the purpose of the visit.

LPA and Administrator conducted a tour of the interior and exterior of the facility. Areas toured include but not limited to: three (3) resident bedrooms, one (1) bathroom, kitchen, common areas, garage and backyard.
LPA observed required furniture, and lighting throughout the residents' bedrooms and facility. LPA observed residents' bathroom to be clean, sanitary, and in good repair. LPA observed food supplies of non-perishables for a minimum of seven (7) days and perishable foods for a minimum of two (2) days. Toxins, knives and cleaning supplies are locked and inaccessible to residents in care. The hot water temperature was measured in the kitchen sink at 108.2 degrees Fahrenheit, which is within the required range of 105 to 120 degrees Fahrenheit. LPA observed fire detectors and carbon monoxide alarms to be operable. LPA observed medications to be locked and inaccessible to residents in care. First aid kit completed. LPA observed required Licensing posters posted throughout the facility. LPA reviewed a total of two (2) resident files and one (1) staff file.

The following shall be updated and submitted to Community Care Licensing by 09/09/2024:
  • LIC 500 facility personnel or staff schedule
  • LIC 308 designation of administrative responsibility
  • A copy of the current liability insurance
  • A copy of Administrator Certificate

No deficiencies are being cited during today's inspection.

Exit interview conducted and a copy of the report was left at the facility.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE: DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/04/2024
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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