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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803301
Report Date: 07/13/2021
Date Signed: 07/13/2021 01:03:51 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: 6DATE:
07/13/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Dante GintoTIME COMPLETED:
01:30 PM
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Licensing Program Analyst Leibert arrived unannounced for the purpose of conducting Legal/Non-Compliance visit. LPA met with staff, Administrator Dante Ginto, and toured the facility and grounds. LPA reviewed documents; inspected kitchen and food supply and asked questions regarding food service; Covid precautions; staffing; and training, in addition to making general observations. The grounds were free of any apparent hazards. Fresh and non perishable food in adequate supply. Residents were having lunch at the time LPA arrived and observed broccoli; beef; rice; fruit cups being served.

Agreements made by Mr. Ginto at the Non-Compliance meeting of April 21, 2021 were reviewed. Three of the six areas of concerned have been addressed satisfactorily. However, some issues remain: Food receipts were required as a POC and have not been cleared. Complete training records for staff have not been submitted and many POC's are still outstanding. The Administrator has indicated the POC's and training requirements have been met and will submit proof by end of week. Residents are pleased with the improvements in food service.

When proof of training and cleared POC's are received, facility will be in substantial compliance. LPA will follow-up to insure that the corrections are made.


No citations issue at this visit.
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David LeibertTELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021
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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