486803301-12-22-2020-21-AS-ACAA-BWJQFS-20201222110826

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 486803301
Report Date: 12/09/2020
Date Signed: 12/22/2020 11:09:33 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME:	GRANADA HILLS MANOR		FACILITY NUMBER:	486803301
ADMINISTRATOR:	GUINTO, JOY J.		FACILITY TYPE:	740
ADDRESS:	1442 GRANADA STREET		TELEPHONE:	(707) 651-9299
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94591
CAPACITY:	6	CENSUS: 6	DATE:	12/09/2020
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME BEGAN:	12:31 PM
MET WITH:	Simeon Vinluan & Dante Guinto		TIME COMPLETED:	02:10 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	Licensing Program Analyst (LPA) A. Canela arrived unannounced to Granada Hills Manor Care Home, on 12/9/2020 for the purpose of conducting a case Management inspection to address Health and Safety concerns. Prior to entering the home, LPA disinfected hands, took temperature and put on full PPE. Staff S1 was wearing a surgical mask when he opened the door and S1 only took LPAs temperature, no questions were asked . The home does have a small table set up at the entrance with a sign in book, hand sanitizer and a thermometer. LPA took a tour of the facility and observed 6 residents who were alert and communicated with LPA. Three out of seven auditory alarms were not turned on during inspection. LPA observed food in the refrigerator not properly covered and two drawers full of soggy persimmons. S2 explained these were hers, LPA explained all food in the refrigerator shall be in good condition and those drawers in the refrigerator should be used to place vegetables and lettuce for the residents. LPA observed over the counter and prescription medication and 2 loose razor blades in resident R1's bedroom. LPA also observed medication ointments in resident R3's bedroom. Residents R4's bedroom was observed with blue tape around trimming of the door, R4 expressed there is a draft or cold air that comes in and he is getting cold; the window has blinds but no curtains and a draft of cold air hits R4, as the bed is next to the window. Residents R2's sliding window has 1 pane broken and will need to be replaced. R2 was also observed sitting in a wheelchair in the living room, watching television and R2 was not wearing any pants, Staff S1 explained R2 has a catheter and its difficult to put on pants. LPA informed staff S1, it was a personal rights violation that R2 sat in the living room with no pants and to dress resident or put a gown. Some residents disclosed they have not been receiving snacks and the amount of food is not sufficient. Continuation of report see LIC809-C

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Araceli Canela	TELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2020

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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: GRANADA HILLS MANOR	FACILITY NUMBER: 486803301
	VISIT DATE: 12/09/2020

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A toured the outside of the home and observed large amounts of metal beds, walkers, wheelchairs, mattresses, metal frames and many are torn, rusted and being covered by large pieces of cardboard. Facility will need to remove all items immediately. The patio furniture has cushions that are 90% torn, faded and stains, the facility was asked in the beginning of the year to remove these items and the plan of correction was not received by CCL

During the visit LPA spoke with licensee, Dante over the phone and explained LPAs observations and items that would need to be corrected. LPA also explained, due to Covid-19 precautions, LPA was unable to type the report during the visit and would send it and go over it again.

Prior to leaving, LPA requested medication to be removed from room and handed razor blades to S1 to lock. LPA also requested S2 to cover food items and discard any that did not appear to be in acceptable condition.

Due to time restrains, LPA will conduct a video-visit with licensee and issue citations noted and/or observed during today's visit.

No citations issued at this time. Report emailed to facility to obtain signatures, due to Covid-19 precautions

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Araceli Canela	TELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2020

LIC809 (FAS) - (06/04)

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