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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315001780
Report Date: 05/26/2022
Date Signed: 06/01/2022 10:49:18 AM


Document Has Been Signed on 06/01/2022 10:49 AM - 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:GREENING'S CARE HOMEFACILITY NUMBER:
315001780
ADMINISTRATOR:GREENING, ESTELITAFACILITY TYPE:
740
ADDRESS:1030 HAMAN WAYTELEPHONE:
(916) 740-3358
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:5CENSUS: 5DATE:
05/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Elma DelaCruzTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 5/26/22 to conduct a Annual Inspection utilizing the infection control domain. LPA met with staff and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Additionally, LPA were screened by facility staff upon entering the facility. LPA requested for staff to notify Administrator that LPA is present at the facility to conduct an annual inspection. Administrator arrived.

LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room, and backyard. LPA and licensee completed the infection control domain. Home is in significant compliance. Water temperature was adjusted while LPA was present.
LPA advised: more detailed symptom screening, Fit testing, recording daily sanitizing, regularly monitor water temperature, maintain PRN records and authorization letters, register for Guardian.

LPA requested the following records: Resident roster, staff roster lic 500, proof of insurance, submit an updated facility sketch and LIC 308 (for designees if applicable).

As a result of this visit, no deficiencies were observed. Exit interview conducted and copy of report provided
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2022
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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