475002785-4-18-2022-25-AS-LMUZ-CDTQ7D-20220425115458

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 475002785
Report Date: 04/18/2022
Date Signed: 04/18/2022 03:17:14 PM

Unfounded

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
04/14/2022 and conducted by Evaluator Dawn Keane

COMPLAINT CONTROL NUMBER: 25-AS-20220414154803

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: 20	DATE:	04/18/2022
		UNANNOUNCED	TIME BEGAN:	01:41 PM
MET WITH:	Alma Peralta, Community Director		TIME COMPLETED:	03:27 PM

ALLEGATION(S):

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Facility has not had running water for 7 days.

INVESTIGATION FINDINGS:

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On 04/18/22 at 1:45 p.m. Licensing Program Analyst (LPA) Dawn Keane conducted an unannounced complaint investigation visit regarding the above allegations and met with Alma Peralta, Community Director (CD). Prior to initiating the complaint 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 contacted Administrator and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical mask. Additionally, LPA was screened by staff person. LPA Keane advised CD of the allegations stated above. During the visit, LPA interviewed two (2) staff and (2) residents and requested staff roster and resident roster. This agency has investigated the complaint alleging the Facility has not had running water for 7 days. We have found that the complaint was Unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis
There were no citations issued during today's visit. An exit interview was conducted.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Dawn Keane	TELEPHONE: (530) 895-2660
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2022

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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