315002155-6-7-2021-27-AS-MSEY-C3YP24-20210614105519

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315002155
Report Date: 06/07/2021
Date Signed: 06/07/2021 10:34:54 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/22/2020 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 27-AS-20201022103541

FACILITY NAME:	GREENING'S CARE HOME II		FACILITY NUMBER:	315002155
ADMINISTRATOR:	GREENING, ESTELITA		FACILITY TYPE:	740
ADDRESS:	4531 WATERSTONE DRIVE		TELEPHONE:	(916) 865-4241
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95747
CAPACITY:	6	CENSUS: 4	DATE:	06/07/2021
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	ROBERT MARIANO		TIME COMPLETED:	10:50 AM

ALLEGATION(S):

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Facility did not meet the needs of a resident.

INVESTIGATION FINDINGS:

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Donna Gurriere, Licensing Program Analyst met with Robert Mariano, House Manager/Care Provider. The allegation pertains to a resident referred to as Resident 1. It was alleged that the Facility is not meeting the needs of a resident.

During the interview process, the licensee, two staff persons, and three current residents were interviewed. Resident 1 was not interviewed, as he has since moved; however, the resident's Physician Report and Admission Agreement were reviewed. The staff persons and the current residents all reported that staff are available to meet their needs to include bathing, redirection, getting dressed, grooming, toileting, meals and medications. The overall senses were that staff meet the needs of the residents.

Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, and the findings are Unsubstantiated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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