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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315001780
Report Date: 06/28/2024
Date Signed: 06/28/2024 12:50:11 PM


Document Has Been Signed on 06/28/2024 12:50 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



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: 4DATE:
06/28/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Lita Greening, Administrator and Andy Greening, Administrator TIME COMPLETED:
12:55 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection following receipt of information relating to resident (R1). LPA met with Lita Greening, Administrator and Andy Greening, Administrator, and stated the reason for today's inspection.

LPA discussed the specific information received from an outside source relating to (R1) with both Administrators. LPA and Administrator toured the facility, including the following areas: resident bathrooms, refrigerator/freezer food, smoke/monoxide alarms, filtered water from the refrigerator, and reviewed documentation related to the medication records.

LPA observed that an antibiotic medication for (R1) that was filled on 6/21/24. Administrators confirmed the medication was picked up on 6/22/24 and the 8:00 pm dosage was administered on 6/22/24. (R1) was taken to the hospital on Sunday, 6/23/24, and was then transferred to another hospital/rehab in his health care group, where he remains for up to two weeks.

LPA interviewed one resident (R2) about the food and water served at the facility. LPA observed (3) residents to be in their rooms during the inspection.

Also discussed was Regulation 87224/Eviction Procedures. LPA printed a copy of the regulation for easy reference.

There are no deficiencies issued in this report.

Exit interview. Copy of report provided to the Administrators.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2024
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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