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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002064
Report Date: 02/10/2023
Date Signed: 02/10/2023 11:55:09 AM


Document Has Been Signed on 02/10/2023 11:55 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
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:SENIOR CARE OF GRANITE BAYFACILITY NUMBER:
315002064
ADMINISTRATOR:COSTEA, DANIELFACILITY TYPE:
740
ADDRESS:9500 EDWARD COURTTELEPHONE:
(916) 768-4447
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY:6CENSUS: 6DATE:
02/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:34 AM
MET WITH:Daniel CosteaTIME COMPLETED:
12:15 PM
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LPA Melissa Parks and LPA Ryan Ayers arrived on Friday February 10, 2023 to conduct the annual inspection. Prior to the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; LPAs ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask and surgical mask.

LPAs and Licensee toured the facility together to ensure health and safety of residents in care. In the areas toured, no immediate health, safety, or personal rights violations were observed. LPAs discussed the process for increase in capacity and fit testing.

LPAs and Licensee completed the infection control domain together and facility was found to be in substantial compliance at this time. LPA Ayers reviewed 3 resident files.

No deficiencies are being cited as a result of todays inspection. Exit interview conducted. A copy of this report was left at the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2023
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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