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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496800457
Report Date: 09/09/2021
Date Signed: 09/09/2021 02:20:42 PM

Document Has Been Signed on 09/09/2021 02:20 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:GRANADA MANORFACILITY NUMBER:
496800457
ADMINISTRATOR:ILAN, CHEYFACILITY TYPE:
740
ADDRESS:4760 GRANADA DR.TELEPHONE:
(707) 539-7059
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY: 6CENSUS: 6DATE:
09/09/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Chey IlanTIME COMPLETED:
02:30 PM
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Licensing Program Analyst Leibert arrived unannounced for the purpose of conducting POC visit for citation issued on 9/2/2021 for personal rights deficiency. Administrator had agreed to train staff due to a finding that residents were being required to go to bed at 8 or 8:30 each night. Further conversation this date indicates that the administrator is the night staff and that other staff are not on NOC duty. LPA reviewed Administrator's certification and verified that she is current. After discussion LPA is satisfied that Administrator understands that residents have personal rights that preclude a fixed bedtime. Citation cleared.


No deficiencies cited this date.
SUPERVISORS NAME: Carla Martinez
LICENSING EVALUATOR NAME: David Leibert
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2021
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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