475002785-7-7-2022-25-AS-MSEY-CG8L57-20220711082636

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 475002785
Report Date: 07/07/2022
Date Signed: 07/07/2022 02:54:32 PM

Unsubstantiated

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
06/28/2022 and conducted by Evaluator Misty Valencia

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20220628165346

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: 17	DATE:	07/07/2022
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Jackie Greico, Office Manager		TIME COMPLETED:	11:45 PM

ALLEGATION(S):

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Facility has been without hot water for approximately five days.

INVESTIGATION FINDINGS:

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On 07/06/2022,, Licensing Program Analysts (LPA) Misty Valencia conducted an unannounced complaint investigation visit regarding the above allegation directed by the department. LPA met with Jackie Greico, Office Manager and explained the reason for the visit.

Prior to initiating 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; 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: N-95 mask, gown and and gloves. Additionally, LPA was screened by staff at the front door.

continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

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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Control Number 25-AS-20220628165346

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: GRENADA GARDENS SENIOR LIVING, LLC	FACILITY NUMBER: 475002785
	VISIT DATE: 07/07/2022

NARRATIVE

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The department investigated Facility has been without hot water for approximately five days allegation and during interviews with licensee, three of three (3/3) staff, four of four (4/4) residents, tour of facility and records reviewed it was determined that the allegation to be un-substantiated.

Facility has been without hot water for approximately five days

Interviews concluded that the facility was without water for only a few hours due to a broken pipe. Maintenance staff had to drive to another state to get a part and drive back, that same day. Residents interviewed reported that they have never had any issues or concerns besides not having hot water for a short period of time, but never was without, bathing, food and drinking water. LPA toured facility and observed that the staff break room 102, shower room 103, residents rooms 101, 104, 105, 110, 124, 125, all had running hot and cold water.

The preponderance of evidence standard has not been met. The allegation is Unsubstantiated.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted, and report emailed to Administrator.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC9099 (FAS) - (06/04)

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