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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 475002785
Report Date: 02/15/2024
Date Signed: 02/15/2024 01:42:11 PM


Document Has Been Signed on 02/15/2024 01:42 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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, LLCFACILITY NUMBER:
475002785
ADMINISTRATOR:BURSTEIN, NAFTALIFACILITY TYPE:
740
ADDRESS:424 HIGHWAY A-12TELEPHONE:
(530) 436-2514
CITY:GRENADASTATE: CAZIP CODE:
96038
CAPACITY:90CENSUS: 23DATE:
02/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:08 PM
MET WITH:Mike Burstein AdministratorTIME COMPLETED:
02:15 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
On 2-15-24 at 12:30 PM Sarah Benson Licensing Program Analyst LPA met with Mike Burstein Administrator and Alma Peralta to clear 809-D dated 06-21-23. LPA Benson reviewed staff files to verify TB test have been completed for all staff members. All staff members have TB testing completed. The POC has been cleared.

LPA Benson tested the water temperature in two resident rooms and the laundry room to verify the temperature is within required limits. The laundry room water temperature tested at 110 degrees and the laundry room at 111 degrees. The resident room farthermost from the water heater tested at 97 degrees after 15 minutes. Administrator stated he has been in contact with his plumber and is going to install a recirculation pump to move the hot water more efficiently.

LPA Benson inquired if Gigi's restaurant approval with Environmental Health has been completed. Administrator stated Environmental Health rescheduled the inspection for February 21, 2024.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Sarah BensonTELEPHONE: 530-895-5033
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2024
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