<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577000418
Report Date: 04/27/2021
Date Signed: 07/14/2023 05:39:24 PM


Document Has Been Signed on 07/14/2023 05:39 PM - It Cannot Be Edited

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:GRAND RIVER CARE CENTER-WESTFACILITY NUMBER:
577000418
ADMINISTRATOR:PAZ, DIANAFACILITY TYPE:
740
ADDRESS:509 MICHIGAN BOULEVARDTELEPHONE:
(916) 373-1591
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY:30CENSUS: 12DATE:
04/27/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Diana Paz, Administrator TIME COMPLETED:
01:30 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 Analysts (LPA) K. Canela contacted Grand River Care Center-West Facility by phone on 04/27/2021, for the purpose of discussing the facility COVID-19 protocol. LPA spoke with Diana Paz, Administrator. Due to COVID – 19 precautions a facility visit is not able to be conducted at this time.
Administrator and LPA discussed the facility visitation practices, vaccine status, and ongoing surveillance testing. Administrator stated the facility is following COVID-19 precautions, such as:
· Screening visitors, staff, and residents
· Taking temperatures for visitors, staff, and residents
· Mandatory mask wearing for staff and optional mask wearing for residents
· Sanitizing hands regularly and upon entering the facility
· Surveillance testing conducted twice a week for staff
· Staff and residents were provided vaccine guidance and assistance
· Offering options for visitation: phone calls, virtual visits, as well as in-door and out-door visitation (with COVID-19 precautions)



No deficiencies cited during today's visit.

*Signatures in file.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Karina CanelaTELEPHONE: 707-588-5054
LICENSING EVALUATOR SIGNATURE:
DATE: 04/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1