<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002984
Report Date: 11/22/2022
Date Signed: 11/22/2022 11:52:20 AM

Document Has Been Signed on 11/22/2022 11:52 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:GRANITE MEADOW HOMEFACILITY NUMBER:
315002984
ADMINISTRATOR:SORONGON, ESPERANZAFACILITY TYPE:
734
ADDRESS:3115 GRANITE MEADOWS LNTELEPHONE:
(650) 580-3896
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY: 5CENSUS: 4DATE:
11/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Judee CastroTIME COMPLETED:
12:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
LPA Parks arrived on Tuesday November 22, 2022 to conduct a case management visit. This was a joint visit with Program Clinical Consultant Helen Shi. 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; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask.

LPA and PCC toured the facility with Assistant Administrator Judee Castro, RT Ray Libang, and RT Jon Peleo.

LPA reviewed the knowledge and skills competency for S1. Additionally, LPA reviewed staff training completed to date. PCC Helen reviewed clinical binder for R1. LPA obtained a copy of hospital discharge paperwork for R1. PCC recommended portable suction machine in shower room for each client. Facility to prepare procedures for staff to follow when using portable suction machine.

No deficiencies cited. Exit interview conducted. Due to printer issues, LPA emailed a copy of the report to Judee Castro and Administrator Espie.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1