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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002155
Report Date: 01/26/2022
Date Signed: 01/26/2022 11:07:54 AM

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 HOME IIFACILITY NUMBER:
315002155
ADMINISTRATOR:GREENING, ESTELITAFACILITY TYPE:
740
ADDRESS:4531 WATERSTONE DRIVETELEPHONE:
(916) 865-4241
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:6CENSUS: 3DATE:
01/26/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Estelita Greening, Administrator/LicenseeTIME COMPLETED:
11:20 AM
NARRATIVE
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to open allegations listed above. LPA met with Administrator and Licensee Estelita Greening. LPA arrived to deliver findings into complaint allegations listed above. LPA's 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. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 Masks.
During complaint investigation LPA toured the facility. At the entrance of the facility LPA observed pamphlets and business cards for "Meryl's Care Home". Caregiver stated that the pamphlets and the business cards are the new owners of the home and the name of the facility. LPA spoke to licensee and informed her all advertising for new facility needs to be taken down until the property owners are approved for a new license. Licensee removed pamphlets and business cards while LPA was present.

LPA reviewed eviction procedures and regulations with licensee. In addition, LPA explained to licensee the change of ownership requires and regulations.

Deficiencies cited on 809-D.

Exit interview conducted and appeal rights given.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 HOME II
FACILITY NUMBER: 315002155
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/04/2022
Section Cited

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87207 False Claims . No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility
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This requirement is not met as evidenced by: Based on interviews, licensee had misleading statement regarding the facility which poses a potential health and safety risk to resident's in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2022
LIC809 (FAS) - (06/04)
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