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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201152
Report Date: 07/14/2022
Date Signed: 07/14/2022 01:07:08 PM


Document Has Been Signed on 07/14/2022 01:07 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:GREENRIDGE SENIOR LIVINGFACILITY NUMBER:
079201152
ADMINISTRATOR:SINGH, RUBYFACILITY TYPE:
740
ADDRESS:2150 PYRAMID DRIVETELEPHONE:
(510) 758-9600
CITY:RICHMONDSTATE: CAZIP CODE:
94803
CAPACITY:38CENSUS: 10DATE:
07/14/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ruby Singh, AdministratorTIME COMPLETED:
01:10 PM
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On 07/14/2022 at 10:00 AM Licensing Program Analyst (LPA) L. Holmes arrived to conduct an unannounced Pre licensing - Change of Ownership inspection. There was a COVID-19 positive sign at the front door of the SNF unit and LPA was greeted by a Caregiver who confirmed that the facility is in the red zone. LPA asked was the Administrator Ruby Singh (ADM) available and the caregiver directed LPA to the assisted living unit; the unit does not have any COVID-19 positive cases. At 10:10 AM Caregiver Meenu Bhatia contacted ADM and said she'd arrive in about 10 minutes. At 10:20 AM, ADM arrived and LPA explained the purpose of the visit. The facility's fire clearance was approved for thirty-eight (38) of which all may be non-ambulatory.

LPA toured facility with ADM including, but not limited to residents' bedrooms, 1 bathroom, kitchen/dining area, common areas, and backyard. Bedrooms and common areas were equipped with the proper furniture and lighting. The bathroom was equipped soap, paper towels and a covered garbage can will be added by ADM. ADM will add 20 seconds to handwashing signs in the kitchen/dining area and bathroom. Linens and supplies were observed in tack. Meals are prepared at the main kitchen facility and there is a storage unit on site for the surplus of food. Lighting is sufficient throughout the facility. The room temperature was maintained at 70 degrees F and hot water temperature was maintained at 119.9 degrees F. First-aid kit was observed complete. Smoke and carbon monoxide detectors were operational and alerts the fire department directly. Two (2) fire extinguishers were last serviced on 03/03/2022. Component III reviewed and completed with ADM and an RN.
During record reviews, LPA reviewed ten (10) resident and ten (10) staff records. The records were current and maintained; there are two (2) hospice residents.

LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications 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 Ruby Singh, Administrator.




SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha HolmesTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2022
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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