486803301-4-23-2021-21-AS-ACAA-C2CV8F-20210423161241

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 486803301
Report Date: 04/21/2021
Date Signed: 04/23/2021 04:12:47 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 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: 5	DATE:	04/21/2021
TYPE OF VISIT:	Office	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Joy and Dante Guinto		TIME COMPLETED:	11:02 AM

NARRATIVE

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Regional Manager, Carla Nuti-Martinez and Licensing Program Analyst (LPA) Araceli Canela made contact on this date, via tele-visit, with Licensee/Administrator, Joy and Dante Guinto for the purpose of reviewing reports for Non-Compliance Conference. It is being conducted by tele-visit phone due to COVID - 19 precautions.

Due to areas of concern identified by the Department, Non Compliance Conference was held. Verbal commitment from Licensees were received for Non-Compliance plan during conference.
Non Compliance Conference was held to discuss areas of concern including:

Personal Rights of residents.

Incidental Medical and Dental Care requirements- medications not locked.

General Food Service Requirements.

Training Requirements.

Maintenance & Operation.

POCs not resolved by agreed upon POC date, currently outstanding and Covid-19 procedures.

Continue report see LIC809-C

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Araceli Canela	TELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2021

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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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: 04/21/2021

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The following information was provided and discussed with facility:

Copies of outstanding POC’s were provided during this meeting.
Copies of PIN 20-38 and 21-17 were provided.
Links to LHI for surveillance testing was provided.
Link to Self-Assessment guide for RCFE

*Per your request to close your other facility Golden Hearts you will be submitting a closure plan as there are no clients in care and have not been since Dec 2020.

Parties agreed on the two year compliance plan; refer to LIC 9111
Facility was provided CCLD website: www.ccld.dss.ca.gov to review Self Assessment Guide, Pins and additional Resource Guides for Licensees.

This report was emailed to facility to obtain signature.
No deficiencies cited during the Non-Compliance Conference

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Araceli Canela	TELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2021

LIC809 (FAS) - (06/04)

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