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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315002155
Report Date: 01/26/2022
Date Signed: 01/26/2022 11:08:43 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
01/24/2022 and conducted by Evaluator Bethany Mirlohi
COMPLAINT CONTROL NUMBER: 25-AS-20220124123307
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
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Estelita Greening, Administrator/LicenseeTIME COMPLETED:
11:20 AM
ALLEGATION(S):
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Licensee does not have control of property
INVESTIGATION FINDINGS:
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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.
LPA investigated the allegation "Licensee does not have control of property". LPA interviewed administrator in which she stated they have sold the property to new owners who intend to apply for their own license. Administrator stated she does not have a lease back for the property. Due to the information gathered LPA finds allegation to be SUBSTANTIATED. Deficiencies on 9099-D. Appeal rights provided.
Substantiated
Estimated Days of Completion:
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.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
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
01/24/2022 and conducted by Evaluator Bethany Mirlohi
COMPLAINT CONTROL NUMBER: 25-AS-20220124123307

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
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Estelita Greening, Administrator/LicenseeTIME COMPLETED:
11:20 AM
ALLEGATION(S):
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2
3
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5
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9
Facility does not have required posters posted
INVESTIGATION FINDINGS:
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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.
LPA investigated the allegation, "Facility does not have required posters posted". LPA toured the facility and observed interior painting on walls were actively being completed. All signs and paintings were taken down temporarily while painting is being completed. LPA observed facility license and other required signs on kitchen table while painting is being completed. Administrator understands once painting is complete and dry, required signs must be posted in common areas. Due to the information gathered LPA finds allegation to be UNFOUNDED.
Unfounded
Estimated Days of Completion:
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.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 25-AS-20220124123307
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
HSC
1569.191(b)
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ยง1569.191 Sale of licensed facility; resulting issuance of new license; procedure. (b) Except as provided in subdivision (e), the property and business shall not be transferred until the buyer qualifies for a license or provisional license within the appropriate provisions of this chapter.
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Licensee agrees to obtain a lease back from new property owner. Lease agreement to be sent into CCL by 2/04/2022.
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This requirement is not met as evidenced by: Based on record review and interviews, licensee does not have control of property 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
LIC9099 (FAS) - (06/04)
Page: 3 of 3