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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803301
Report Date: 11/09/2021
Date Signed: 12/02/2021 03:52:04 PM

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 MANORFACILITY NUMBER:
486803301
ADMINISTRATOR:GUINTO, JOY J.FACILITY TYPE:
740
ADDRESS:1442 GRANADA STREETTELEPHONE:
(707) 651-9299
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:6CENSUS: 5DATE:
11/09/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:16 PM
MET WITH:Dante GuintoTIME COMPLETED:
12:17 PM
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LPA Canela conducted this unannounced Case Management inspection and met with care staff Simeon Vinluan. Licensee, Dante Guinto arrived later.
LPA went over corrections that were sent from previous inspection.
LPA had requested a written plan regarding food and that facility plans ahead on what will be served for breakfast, lunch and dinner according to residents dietary needs. Licensee provided pictures of some food, but LPA did not receive an action plan. Facility has been struggling with issues concerning food, how it is stored, what is being served, what food is available to meal plan and following a meal menu/snacks.

Facility has also been issued prior citations for extra assistance devices, such as wheel chairs, hospital beds and walkers being stored in the side yard. Today LPA observed 5 wheel chairs in the yard, they all appear in good condition but the facility is not storing them properly and all 5 wheel chairs and a hospital bed mattress are observed in the rain. These items need to be cleaned, dried and stored where they are covered for their protection.

LPA requested written plans in order to clear citation regarding food items.
No citations issued during this visit.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Araceli CanelaTELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021
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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