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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201152
Report Date: 07/26/2023
Date Signed: 07/26/2023 04:39:58 PM


Document Has Been Signed on 07/26/2023 04:39 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:GREENRIDGE SENIOR LIVINGFACILITY NUMBER:
079201152
ADMINISTRATOR:SINGH, RUBYFACILITY TYPE:
740
ADDRESS:2150 PYRAMID DRIVETELEPHONE:
5107589600
CITY:RICHMONDSTATE: CAZIP CODE:
94803
CAPACITY:38CENSUS: 12DATE:
07/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Patrick Blanc, Administrator TIME COMPLETED:
04:50 PM
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On 07/26/23 at 09:30 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced for the required annual inspection. LPA met with Patrick Blanc, Administrator (ADM) and explained the purpose of the visit. ADM currently holds a standard certificate (#6065998740) that expires on 06/26/25. The facility’s fire clearance was approved for thirty-eight (38), nine (9) non-ambulatory residents; tens (10) may be hospice.

Upon arrival, LPA observed three (3) staff attending to three (3) residents having breakfast. LPA and ADM toured the facility, including but not limited to, common areas, bathrooms, kitchen, dining room, front area and courtyard(s). All outdoor and indoor passageways were free of obstruction. There were no bodies of water present. A comfortable temperature was maintained at 72 degrees Fahrenheit (F). LPA observed lighting in all areas to be adequate for the comfort and safety of the residents. The hot water temperature was measured at 116.2 degrees (F). All shared restrooms, hand washing, and bathing areas were safe, sanitary and in operating condition. Hand washing signs, paper towels, and soap observed at all hand washing stations. Linen and hygiene products are available for all residents. PPE, sanitizer, and paper goods remain sufficient.

...continued on LIC809C.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha HolmesTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2023
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 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: GREENRIDGE SENIOR LIVING
FACILITY NUMBER: 079201152
VISIT DATE: 07/26/2023
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...continued from LIC809

There was a sufficient supply of 2-day perishables and 7-day supply of non-perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was observed full and serviced 07/12/23. Emergency Disaster Plan is updated. Safety drills were last conducted 06/2023 and are rotational between AM and PM schedules monthly.

LPA reviewed five (5) staff records and five (5) residents records were reviewed and are complete. ADM to review files for completion.

The following forms are to be updated and submitted to CCLD:
-LIC500 Personnel Report
-LIC308 Designation of Administrative Responsibility
-LIC610E Emergency Disaster Plan (Reviewed)
-An updated copy of Administrator Certificate(s) (Reviewed)

No deficiencies cited during visit.

Exit interview conducted and a copy of this report provided to ADM.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha HolmesTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2