475002785-1-3-2024-59-AS-KHOS-CZRSU6-20240123131036

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 475002785
Report Date: 01/03/2024
Date Signed: 01/03/2024 11:07:37 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/12/2023 and conducted by Evaluator Sarah Benson

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230612114923

FACILITY NAME:	GRENADA GARDENS SENIOR LIVING, LLC		FACILITY NUMBER:	475002785
ADMINISTRATOR:	BURSTEIN, NAFTALI		FACILITY TYPE:	740
ADDRESS:	424 HIGHWAY A-12		TELEPHONE:	(530) 436-2514
CITY:	GRENADA	STATE: CA	ZIP CODE:	96038
CAPACITY:	90	CENSUS: 23	DATE:	01/03/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator Mike Naftali Burstein		TIME COMPLETED:	11:24 AM

ALLEGATION(S):

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Staff do not follow residents' special diets.
Staff does not maintain facility kitchen in a clean and sanitary condition.
Staff do not follow safe food handling practices.

INVESTIGATION FINDINGS:

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On 01-03-24, Licensing Program Analyst (LPA) Sarah Benson arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 06/12/23. LPA Benson met with Administrator Mike Naftali Burstein,and explained the purpose of the visit.

During the interview process, the Administrator, nine staff persons, three residents and the chef for GiGi’s restaurant were interviewed. Documents were received and reviewed to include the resident list, staff list with telephone numbers, Resident Admission Agreements, and Physician reports.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Sarah Benson	TELEPHONE: 530-895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

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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Control Number 59-AS-20230612114923

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GRENADA GARDENS SENIOR LIVING, LLC	FACILITY NUMBER: 475002785
	VISIT DATE: 01/03/2024

NARRATIVE

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Staff do not follow residents' special diets.

During the interview process, all staff members stated at least one resident with a special dietary need. During interviews, staff revealed the paper by the sink in the bistro area and a list posted on the communication board, notifies staff of residents with special diets. Staff reported residents with special diets are labeled with resident name. While interviewing, GiGi’s chef stated all residents meals with special diets are labeled and set aside. During the interview process the chef verified residents with special diets coincided with resident’s physicians’ orders.

During the investigative process LPA Benson observed each resident table setting has the name of resident and diet posted to notify staff when serving of special diets.

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

Staff does not maintain facility kitchen in a clean and sanitary condition.

According to the licensing documents submitted at the time of licensing the kitchen is a separate legal entity, not licensed with the California Department of Social Services, Community Care Licensing.

Although the allegations may have happened or are valid, based on interviews, observations and evidence obtained during the investigation the preponderance of evidence standard has not been met, therefore, the above allegation is found to be Unsubstantiated.

Staff do not follow safe food handling practices.

During staff interviews it was reported that all staff wear gloves when serving the residents food. Staff reported washing hands before and after putting on the gloves. Staff reported the food is placed in covered, warming trays for safe food handling. The Chef for Gigi’s restaurant reported having a California Safe Food Handling license.

During the investigative process LPA Benson observed that meals are served in a clean designated dining area suitable for the residents. LPA Benson observed that staff wore gloves while serving meals.

Based on interviews, observations and evidence obtained during the investigation the preponderance of evidence standard has not been met, therefore, the above allegation is found to be Unsubstantiated.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Sarah Benson	TELEPHONE: 530-895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

LIC9099 (FAS) - (06/04)

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