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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002064
Report Date: 03/18/2025
Date Signed: 03/18/2025 04:03:58 PM

Document Has Been Signed on 03/18/2025 04:03 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:SENIOR CARE OF GRANITE BAYFACILITY NUMBER:
315002064
ADMINISTRATOR/
DIRECTOR:		COSTEA, DANIELFACILITY TYPE:
740
ADDRESS:9500 EDWARD COURTTELEPHONE:
(916) 768-4447
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
03/18/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Administrator - Daniel CosteaTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Graham Gunby arrived on Tuesday March 18, 2025 to conduct the unannounced annual inspection.

During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed resident (6) and staff (3) files. All resident files contained the required paperwork. All staff files contained the required paperwork and training.

LPA and Admin toured the facility together to ensure the health and safety of resident in care. The areas toured included bedrooms, bathrooms, kitchen, common areas, back yard and garage. All chemicals, toxins, and sharps were kept locked and inaccessible to residents. Facility has two (2) fire extinguishers. In the areas toured, there were no health or safety violations observed.

LPA obtained current liability insurance.

No deficiencies cited. Exit interview conducted. A copy of this report was emailed to the Administrator.
Troy OrdonezTELEPHONE: (916) 263-4832
Graham GunbyTELEPHONE: (916) 827-6870
DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2025
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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