Granada Manor

Type of visit: Required - 1 Year

At approximately 8:35 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit. Administrator Chey Ilan was not at the facility during the inspection. Granada Manor is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for six (6) non-ambulatory residents. Upon arrival, LPA was informed that there were five (5) residents in care and one (1) staff member on-site. At approximately 8:50 AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 9:00 AM, LPA toured the facility. All exits were clear and unobstructed. The facility's two (2) fire extinguishers were last serviced and tagged on 8/21/2025. The facility was sufficiently lighted. LPA inspected three (3) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. LPA observed that there were multiple canned and dried food products in the pantry closet that have expired. This deficiency will be cited. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. In the front living room LPA observed multiple prescription and over the counter (OTC) medications that were unsecured. This deficiency will be cited. Additionally, there were unsecured toxins in the front living room. This deficiency will be cited. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills quarterly. The last disaster drill was conducted in 8/2025. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and observed to be operational. Continued on 809-C... ...Continued from 809 Next to the front living room is a staff room. This room contained toxins and the room is not being locked which leaves the toxins accessible to residents. This deficiency will the cited. Within the garage there is one (1) staff bedroom as noted on the facility drawings that was approved by the Santa Rosa Fire Department during their inspection on 7/2/2020. During today's inspection LPA observed that this one (1) bedroom has been split into two (2) separate rooms. The added room (in the far corner of the garage) was observed to contain computers and servers with unsecured data and power cables strung across the ceiling and floors. The Licensee has not submitted updated facility drawings showing this added room to Community Care Licensing (CCL) so that CCL can request the Santa Rosa Fire Department to inspected the added room. This deficiency will be cited. At approximately 10:50 AM, LPA reviewed five (5) resident files. Five (5) of five (5) resident files were observed with all required documentation. LPA reviewed five (5) staff files. Three (3) of five (5) staff files (for staff members S1,S2 & S3) were observed not have documentation of annual training for the current year. This deficiency will be cited. Two (2) of five (5) staff files were observed with all required documentation including First Aid and CPR certification and proper training documentation. LPA spot checked Medication for two (2) residents. LPA observed all medications to be centrally stored, secure and with proper documentation. The facility does not handle resident’s monies for personal and incidental items. Chey Illan’s Administrator Certification 7005493740 is current with an expiration date of 8/7/2026. LPA requested the following documents be submitted to Community Care Licensing by 12/23/2025: LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Proof of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809Ds, Plan of Corrections, 811 Confidential Names and Appeal Rights discussed and provided to Licensee Anderson. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Nov 24, 2025

Type of visit: POC

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a plan of correction visit and was greeted by Licensee Clayton Anderson. On 11/18/24 during the required annual inspection, LPA discussed with licensee providing sufficient space for residents to use for activities and leisure. The facility's living room is currently occupied by licensee's alleged non-resident client and being used as a bedroom. LPA and licensee discussed making living room accessible to residents in order to maintain compliance with regulation. Deficiency of regulation 87219(h) was cited on a 809D with the following plan of correction: Facility to submit plan to CCL for approval of how they will make the facility living room accessible to residents to use for visitation, activities, and leisure by plan of correction due date. If plan is approved, implementation of plan to be completed no later than 12/9/2024. Plan received on 11/26/24. Upon arrival today, 12/19/24 LPA observed the door to the space that is supposed to be a living room to be closed. When LPA opened the door, the alleged non-resident client was present eating a meal in the recliner. The room had not been cleared of the alleged non-resident client belongings or bed. LPA asked licensee why the room had not been cleared out and made for resident use like the plan of correction required be done by 12/9/24. Licensee claims that they were waiting on the LPA to officially approve the plan. LPA did approve the plan submitted to CCL on 11/26/24, but LPA could not produce email with approval. Therefore, one week is being granted to the licensee so that they may fulfill the plan of correction. As of today, LPA has officially approved the plan to move the alleged non-resident client to the designated staff room identified as staff room on the facility sketch, so that the full living room will be fully available to residents and the door to living room removed. The full living room to be fully available to residents, with the door to living room removed, no later than 12/26/24. Continued on 809C... Continued on 809... LPA will return to facility to conduct a subsequent plan of correction visit to verify the full living room is fully available to residents and the door to living room was removed. Additionally, licensee claimed space on the other side of the bookshelves in the living room is used as a COVID sick room for residents. LPA advised a COVID sick room is not required per regulation. LPA also clarified with licensee that the area in the living room blocked off by bookshelves is not a sick room, it is part of the living room; it is a designed sleeping area that may not be used. LPA advised licensee will need to come to the Santa Rosa regional office to have a meeting to discuss areas of concern. Date of office meeting will be determined and LPA will notify licensee of date of office meeting. No deficiencies cited. Exit interview conducted with licensee and copy of report given.the state’s words, verbatim · CDSS document, Dec 19, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by Licensee Clayton Anderson. LPA and licensee toured the building and grounds. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered. Freezer located in the garage needs to be cleaned out and all expired items removed. Kitchen cabinet containing cleaning supplies was locked. Kitchen drawer with sharp knives locked. All bedrooms were equipped with lighting, night stand, and chest of drawers. Dead insects found in the window sill of rooms #1 and #2. Resident bathroom had required bath mat and grab bar. Water temperature in sink accessible to residents in care measured at 109.3 and 112.5 degrees F which is within the allowable range of 105 to 120 degrees F. Upon LPA arrival to facility, passageway was blocked due to multiple walkers being present (deficiency cited, see 809D). LPA discussed with licensee providing activities for the residents that meet regulation. Currently, the facility does not offer an activity program that addresses the needs and limitations of residents with dementia which include large motor activities and perceptual and sensory stimulation (deficiency cited, see 809D). Additionally, LPA and licensee discussed activities and providing room enough in the facility for activities and visitation. There are six [6] residents and [4] possible seats to sit in. The only indoor area accessible to residents for activities and for recreation is the small dining area occupied by dining table with chairs, one small love seat, and 3 recliners. LPA discussed with licensee providing sufficient space for residents to use for activities and leisure. The facility's Living room is currently occupied by licensee's alleged non-resident client and being used as a bedroom. LPA and licensee discussed making living room accessible to residents in order to maintain compliance with regulation (deficiency cited, see 809D). Continued on 809C... Continued from 809... Fire extinguishers were last inspected 8/27/24. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drills were conducted 10/30/2024. Emergency fire exit path on right facing side of the facility is blocked by multiple items (deficiency cited, see 809D). Ramp on deck leading to grass has a soft spot and is broken/worn through. Tree House and ladder on tree in backyard is not secured, must be made inaccessible to residents (deficiency cited, see 809D). LPA conducted a review of six [6] resident records. R1 and R2 do not have current appraisals (deficiency cited, see 809D). LPA conducted review of five [5] staff records. S1, S2 did not have current 1st Aid/CPR (deficiency cited, see 809D). LPA reviewed training materials used for staff training. Medications training is conducted using a manual from 2001 and other topics on burned CD discs dated 2015. Licensee to either use an approved vendor for training or submit updated training materials to CCL for approval no later than 12/2/2024. LPA conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. Chey Ilan Administrator Certificate 7005493740 has expired but renewal is pending as of 5/3/2024. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report Liability Insurance Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Licensee. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with licensee and a copy of this report was given.the state’s words, verbatim · CDSS document, Nov 18, 2024

Type of visit: POC

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a Case Management- POC and was greeted by Chey Ilan, Administrator and Clayton Anderson, Licensee. Facility currently has five (5) residents in care. On 11/07/2023 facility was cited for not complying with Title 22 regulation 87705(5) in [3] out of [5] resident records with a diagnosis of dementia, their respective LIC602s were not current within 12 months. LPA discussed with Administrator failure to satisfy plan of correction by due date of 11/28/2023. As of today, the respective LIC602s have not been made current and as such the plan of correction (POC) to correct deficiency has not been corrected. A civil penalty of $100 per day shall be assessed beginning the day after the POC due date of 11/29/2023. The Civil Penalty will continue to accrue at $100 per day until the deficiency is corrected. On 11/07/2023 LPA requested facility send updated LIC500 within 30 days. As of today, 12/12/2023 updated LIC500 has not been received by CCLD. Per LPA interview with Administrator, the only staff currently working with residents are herself and Clayton Anderson, Licensee. Administrator confirmed there are no overnight awake staff currently working. Per Title 22, regulation 87705(c)(4)(A) Care of Persons with Dementia - Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her current appraisal. (A) In addition to requirements specified in Section 87415, Night Supervision, a facility with fewer than 16 residents shall have at least one night staff person awake and on duty if any resident with dementia is determined through a pre-admission appraisal, reappraisal or observation to require awake night supervision (deficiency cited, see 809D). Per LPA interview with Administrator, the only staff currently working with residents is herself and Clayton Anderson, Licensee; however, Licensee does not have current training hours completed. Per Title 22, regulation 87411(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (deficiency cited, see 809D). Continued on 809C... Continued from 809... Per LPA interview with Administrator and Licensee, the room on facility sketch designated as a commonly used living room is currently being used as a sleeping room for non-client resident (NCR1). Per Title 22, regulation 87307(a)(2)B) Personal Accommodations and Services- No room commonly used for other purposes shall be used as a sleeping room for any resident. This includes any hall, stairway, unfinished attic, garage storage area, shed or similar detached building (deficiency cited, see 809D) Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report Copy of Deed or Mortgage Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Licensee. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator and a copy of this report was given.the state’s words, verbatim · CDSS document, Dec 12, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a)(2)B) · Plan of correction due date: Dec 20, 2023

87307(a)(2)B) Personal Accommodations and Services - No room commonly used for other purposes shall be used as a sleeping room for any resident. This includes any hall, stairway, unfinished attic, garage storage area, shed or similar detached building. This requirement is not met as evidenced by: Based on LPA and Administrator interview, the licensee did not comply with the section cited above as resident (NCR1) is currently using room designated as living room as a sleeping room, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 12, 2023

Plan of correction: Facility to submit updated facility sketch with room currently designated as living room updated to show it is a sleeping room for NCR1. Facility to submit by POC date of 12/20/2023. Once updated facility sketch received, CCLD will submit request for fire clearance.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87411(c) · Plan of correction due date: Jan 3, 2024

87411(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69. This requirement is not met as evidenced by: Based on LPA and Administrator interview, Licensee provides care to residents but has not completed required trainings. Required trainings not current.the state’s words, verbatim · CDSS document, Dec 12, 2023

Plan of correction: Administrator to provide proof of completed required trainings for Licensee, Clayton Anderson by POC due date of 01/03/2023.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(c)(4)(A) · Plan of correction due date: Jan 9, 2024

87705(c)(4)(A)Care of Persons with Dementia Licensees who retain residents with dementia shall be responsible for ensuring the following:...have at least one night staff person awake and on duty... This requirement is not met as evidenced by: Based on LPA and Administrator interview the only staff currently working with residents are herself and Clayton Anderson, Licensee. Administrator confirmed there are no overnight awake staff currently working.the state’s words, verbatim · CDSS document, Dec 12, 2023

Plan of correction: Administrator to hire staff, ensuring at least one night staff person is awake and on duty. Administrator to provide proof to CCLD that hired staff has completed all required trainings, obtained background and fingerprint clearance, and are associated to the facility before working with clients in any capacity. Proof to be submitted by POC due date of 1/9/2023.