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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803301
Report Date: 06/29/2021
Date Signed: 06/29/2021 11:24:12 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/08/2021 and conducted by Evaluator David Leibert
COMPLAINT CONTROL NUMBER: 21-AS-20210608115540
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: 6DATE:
06/29/2021
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Dante GintoTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Food services are inadequate
INVESTIGATION FINDINGS:
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Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on the above captioned complaint allegation. LPA met with Administrator, Dante Ginto. Complainant alleges that meals are inadequate, lacking variety, served cold. This Department has investigated this allegation by making unannounced site visits; taking statements from staff and residents; reviewing documents and menus; inspecting kitchen and food supplies. The following determinations have been made: Sufficient fresh and non perishable food observed at site visits; resident statements indicate facility's published menus have not been followed; Three of four residents interviewed indicated that breakfast is usually cereal and toast, lunch is a baloney sandwich, and dinner is chicken and rice with occasional variations; Three of four residents also complain that food is served cold and, on one recent occasion, a green salad was microwaved and served to residents. Based upon statements taken; documents reviewed; and LPA observations, the preponderance of evidence standard has been met. Therefore, the allegation is SUBSTANTIATED.

******Continued on second page*****

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David LeibertTELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 21-AS-20210608115540
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 06/29/2021
NARRATIVE
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 The following deficiencies were observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David LeibertTELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 21-AS-20210608115540
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/29/2021
Section Cited
CCR
87468(a)(5)
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87468(a)(5) Personal Rights of residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (5) To be served food of the quality and quantity necessary to meet their nutritional needs. ***Based on statements and observations, this

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Administrator has submitted proof of improved food service and training for staff in food service and facility maintenance. Cleared at time of visit.

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requirement has not been met as evidenced by: 3 of 4 residents state they are not served a variety of food in adequate portions and insufficient fruits and vegetables. This posses an immediate denial of personal rights.
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Administrator has submitted proof of improved food service and training for staff in food service and facility maintenance. In addition, Administrator will provide training for all staff involved in food preparation on the topic of menu planning by a professional in nutritionist.

Type B
07/13/2021
Section Cited
CCR
87555(b)(5)
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87555(b)(5) General Food Service Requirements. Meals shall consist of an appropriate variety of foods and shall be planned with consideration for cultural and religious background and food habits of residents. ***Based upon statements and observations, his requirement has not been met as evidenced by:
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Proof of compliance to be submitted to CCL by POC date in order to clear deficiency.

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3 of 4 residents state that the food is served cold, in inadequate amounts, not in compliance with published menus, and lacking in variety. This poses a potential risk to the health of the residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David LeibertTELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/08/2021 and conducted by Evaluator David Leibert
COMPLAINT CONTROL NUMBER: 21-AS-20210608115540

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: 6DATE:
06/29/2021
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Dante GintoTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Resident is not receiving medications appropriately
Resident’s needs are not being met

INVESTIGATION FINDINGS:
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Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on the above captioned complaint allegation. LPA met with Administrator, Dante Ginto. Complainant alleges that R1 is not receiving assistance with blood pressure monitoring and medication administration. During course of this investigation the Department has taken statements from staff and residents, reviewed and obtained documents; made site visits and observations. The following determination are made: Staff state that R1 refuses assistance with blood pressure monitoring and that R1’s medications are centrally stored and recorded on the MAR; R1 has made conflicting statements regarding the assistance R1 has received from staff; Inspection of MAR records indicate staff assisted with medications with the exception of one medication administered by R1 according to physician’s order. Based upon the statements made and records reviewed, there is not a preponderance of evidence to prove the allegations are or, are not, true. Therefore, the allegations are UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David LeibertTELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4