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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 01:16:06 PM


Document Has Been Signed on 07/14/2022 01:16 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:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Ruby Singh, Administrator.TIME COMPLETED:
01:20 PM
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On 07/14/2022 at 01:10 PM, while at the facility for Prelicensing, L. Holmes Licensing Program Analyst (LPA) completed a Component III presentation with Ruby Singh, Administrator.

Ruby Singh, Administrator and one (1) additional staff were present, LPA discussed the COVID-19 infection control requirements, the importance of attending the informational calls, understanding the updated guidelines and printing the provider information notices (PINS) for residents, authorized representatives and staff so that the facility maintains awareness and updates for compliancy with the Title 22 regulations.

-Component III completed.

Exit interview conducted and a copy of this report provided to 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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