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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700033
Report Date: 05/11/2022
Date Signed: 05/11/2022 02:32:10 PM


Document Has Been Signed on 05/11/2022 02:32 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:GRANITE BAY COUNTRYHOUSE LLCFACILITY NUMBER:
312700033
ADMINISTRATOR:JESSICA SANDERSFACILITY TYPE:
740
ADDRESS:8485 BARTON RDTELEPHONE:
(916) 899-6565
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY:49CENSUS: 21DATE:
05/11/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
02:08 PM
MET WITH:Jessica SandersTIME COMPLETED:
02:40 PM
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Licensing Program Analysts (LPAs) Lavinia Muscan and Kerry Hiratsuka arrived at the facility unannounced on 05/11/2022, to conduct a Case Management Visit. LPAs conducted COVID-19 Precautionary prescreening, and wore a surgical mask while at facility. LPAs were screened by Front Desk.

LPAs conducted this visit in response to Executive Director (ED) reporting the facility is on fire watch due to the fire panel breaking during routine maintenance. The facility started the fire watch 5/4/2022. ED stated during the visit conducted on 5/5/2022 the fire panel was hopefully going to be repaired by today. ED reported to Community Care Licensing Division (CCLD) on 05/10/2022, she was notified by the fire company the piece for the panel was going to show up on 05/10/2022, or 05/11/2022. During today's visit ED stated the part has not come in yet and the company is hoping it will show up this week. She stated they are still doing the fire watch and shall continue until released by the fire department.

ED shall continue submitting the fire watch logs to CCLD and South Placer County Fire Department until they are released from the fire department. Logs shall be submitted by 5:00 PM everyday. ED shall also keep CCLD and South Placer County Fire Department updated on the status of the repair.

No deficiencies cited.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Lavinia MuscanTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/11/2022
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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