Light of Grace I

On 09/17/2025 at 1:30PM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Fe Lorenzo, Caregiver and explained the purpose of the visit. Administrator, Tarra Adbullah-Grayson, arrived at approximately 1:45PM. The facility’s fire clearance was approved for five (5) non-ambulatory and one (1) bedridden resident. LPA toured facility with Jamie including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of five (5) bedrooms, three (3) bathrooms. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 80 degrees Fahrenheit. LPA observed lighting in all rooms is adequate for the comfort and safety of the residents. The hot water temperature in the resident’s shared bathroom was measured at 109.9 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 7-day supply of nonperishable and 2 days of perishable foods. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced 05/16/2025. First aid kit was observed to be complete. Fire drill was last conducted on 10/10/2025. Emergency disaster plan last updated 10/10/2025. Continues on LIC809C .... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Continued from LIC809. Five (5) staff records were reviewed; all five (5) staff have FirstAid/CPR and were associated. LPA also reviewed all five (5) resident records, and they were complete. LPA requested the following documents to be submitted to CCLD by 11/13/2025 . LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (last page) Liability Insurance Updated Facility Sketch LPA observed no deficiencies during visit. Exit interview conducted a copy of this report provided.

On 12/11/2024 at 1:00PM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced post licensing inspection. LPA met with Barbara McMillion, Caregiver. Barbara contacted Administrator, Tarra Abdullah-Grayson via telephone and advised purpose of visit. Administrator, Tarra Abdullah-Grayson gave authorization to Barbara McMillion to sign the reports. LPA toured facility including but not limited to bedrooms, bathrooms, dining area, living room, kitchen, garage, and outdoor area. Fire extinguisher was observed to be full and last purchased on 05/23/2024. Medications were in a locked cabinet in the kitchen. Comfortable room temperature is maintained at 74 degrees F. Hot water temperature in the shared residents’ bathroom was measured at 111.1 degrees Fahrenheit. One week of non-perishable and 2-day perishable food supplies were sufficient. Carbon monoxide and smoke detectors were observed in operating condition. First-aid kit was complete, and hygiene items for resident general use are sufficient. Extra linens and towels were observed in the hallway closet. Last fire drill was conducted on 11/20/2024. There are no accessible bodies of water observed. LPA reviewed one (1) out of one (1) resident’s record and three (3) staff records starting at around 1:15PM. All staff are fingerprint cleared and associated to the facility. The resident in care has a physician's report, needs & service plan, and admission agreement on file. LPA also reviewed one (1) resident’s medication and medication logs. All PRN medications have physician's orders. LPA attempted to interview resident however, wasn't successful as the resident has dementia and is non verbal. Continue on LIC809C. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Continued from LIC809 No deficiencies cited during visit. The following forms to be updated and submitted to CCL by 12/18/2024: · LIC 500- Personnel Report · LIC 308- Designation of Facility Responsibility · LIC 610E- Emergency/Disaster Plan (9 pages) · Evidence of Liability Insurance Exit interview conducted and a copy of this report provided to Barbara McMillion.

On 11/07/2024 An announced Pre-licensing Comp III associated with Pre-Licensing Inspection done on 11/07/2024 at 12:35PM was conducted by Licensing Program Analyst (LPA) T. Syess-Gibson. Comp III was attended by Tarra Abadullah-Grayson, Administrator/Licensee. LPA concluded Comp III. No citation made during this visit. Exit interview conducted and a copy of this report provided.

On 11/07/2024 at 10:41am, Licensing Program Analyst (LPA) T.Syess-Gibson conducted an announced pre-licensing visit and met with applicant Tarra Adbullah-Grayson, Administrator. LPA explained the purpose of the visit with Administrator. The facility has an approved fire safety clearance for total capacity of six (6) residents, five(5) non ambulatory and one (1) bedridden residents. LPA inspected the facility inside and out including but not limited to the bedrooms, bathrooms, common living areas, kitchen, garage, back yard. The facility has five (5) bedrooms and three (3) bathrooms. One(1) bathroom used by staff only. There is sufficient lighting around the facility. LPA observed all five (5) residents' rooms equipped with proper beddings each bed had clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases and mattress pads. All rooms have proper lighting. LPA observed Bathrooms showers were equipped with grab bars, non-skid mats and hygiene supplies were observed inside cabinet. LPA observed television in the common area and board games for activities. Communal dining room is equipped with sufficient tables and chairs for the residents. All toxins were locked inside the laundry room . Sharps and disinfectants were locked in cabinet in kitchen. Passageways and hallways were free of obstruction. Fire extinguishers were last purchased on 05/23/2024. Smoke detectors and Carbon Monoxide detectors were operational. Medication cabinet was locked, and first aid kit was complete. Continue LIC809C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Continue from LIC809 All exit doors in the facility are equipped with auditory signals. Hot water temperature is measured at 116.1 degrees F. Emergency Disaster plans are complete and easily accessible to staff. Comfortable temperature was observed at 72 degrees F No issues noted during this pre-licensing inspection. Component III was conducted with Tarra Abdullah-Grayson on pre-licensing visit dated 11/07/2024. The applicant was reminded of the statute that requires CCL to be notified within 5 business days of admitting their first resident. This notification may be done by phone, by mail, or by fax. LPA observed the facility is ready to be licensed. This report will be submitted to the central application unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required. Exit interview conducted and a copy of this report provided.