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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 475002785
Report Date: 08/19/2020
Date Signed: 08/20/2020 11:12:25 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 COHASETT RD., STE. 170
CHICO, CA 95926
FACILITY NAME:GRENADA GARDENS SENIOR LIVING, LLCFACILITY NUMBER:
475002785
ADMINISTRATOR:BURSTEIN, NAFTALIFACILITY TYPE:
740
ADDRESS:424 HIGHWAY A-12TELEPHONE:
(530) 436-2514
CITY:GRENADASTATE: CAZIP CODE:
96038
CAPACITY:90CENSUS: 24DATE:
08/19/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Director Alma PeraltaTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Misty Valencia conducted a scheduled case management tele-visit in regards to a Health and Safety check. LPA met with Director Alma Peralta. A physical visit was not conducted due to COVID-19. LPA explained purpose of visit and toured the facility inside and out, but not limited to facility kitchen, living room, dining room, outside area, bathrooms, facility office and resident rooms.

Facility has a 7-day non-perishable and 2-day perishable supply of food. Smoke and carbon monoxide detector were observed to be operational. Outside area is free of obstruction and no bodies of water present. Medication are centrally stored in locked Medications room. All hazardous and dangerous objects/items are kept locked and inaccessible to clients.

Records and medication audit was not completed due to visit being completed via tele-visit.

During the tele-visit, LPA and Licensee discussed some COVID-19 precautions measures that the facility have in place and importance of having Personal Protective Equipment (PPE). LPA advised that facility staff treat the facility like a public area and wear masks.

No deficiency was cited. Exit interview was conducted and a copy of this report was sent to Licensee to signed and return to put on file.
SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Misty ValenciaTELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2020
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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