475002785-8-4-2022-25-AS-MVAA-CGYKDC-20220804074832

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 475002785
Report Date: 08/03/2022
Date Signed: 08/04/2022 07:48:37 AM

Document Has Been Signed on 08/04/2022 07:48 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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
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:	08/03/2022
TYPE OF VISIT:	Case Management - Health Checks	UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Administrator Alma Peralta and Licensee Mike Burstein		TIME COMPLETED:	02:30 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 08/03/2022 Licensing Program Analyst (LPA) Misty Valencia, arrived at the facility unannounced to conduct a facility health and safety check due to flooding and fire in the area. LPA met with Administrator Alma Peralta and Licensee Mike Burstein and explained the purpose of the visit. Prior to initiating the annual inspection 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 Facility 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 front office staff On 07/31/2022 LPA contacted Licensee regarding fire in the community. Licensee reported that they are not currently under any kind of evacuation orders, but ready if it does become a mandatory evacuation. on 08/02/2022 at 1038pm, LPA received an email from LTCO (Ombudsman) reporting that the facility was in the middle of a storm and had some flooding going on. On 08/02/2022 licensee contacted EC janitorial services at 628pm who showed up five (5) minutes later and drained as much water he could. at 8:15 Licensee was in contact with LTCO (Ombudsman) regarding the incident and that all the residents were not affected and are safe. At 8:30pm licensee called LPA, but LPA did not answer and it was late so he did not leave a message. on 08/03/2022 while LPA was driving to the facility Licensee called and let LPA know that they had a flood in the building last night.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 08/03/2022

NARRATIVE

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on 08/03/2022 LPA and licensee toured facility together to ensure health and safety of the residents and facility. Due to a thunder storm on 08/02/2022 and excessive rain, the facility front entrance, management offices and dining area flooded. There is no substantial damages, just some water on the water proof flooring. There was about an inch on water in the floors in the front entrance and management offices. There are currently eight (8) dehumidifiers drying the wet flooring. The residents hallways and bedrooms were not affected. Residents ate breakfast in their bedrooms, but the dining room area is cleared and safe for dinner.

The facility is located down hill from a city water drain that clogged and over flowed. The water ran down about five-hundred (500) feet from the city drain to the facility. Emergency Services showed up to pump the water out so it would slow down from going down into facility property.

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and copy of report left at the facility.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2022

LIC809 (FAS) - (06/04)

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