280111959-1-16-2024-21-AS-VBEI-CZL2FG-20240117162130

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 280111959
Report Date: 01/16/2024
Date Signed: 01/16/2024 10:53:50 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/08/2024 and conducted by Evaluator Christopher Arnhold

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20240108094519

FACILITY NAME:	GREENHILLS CARE HOME, THE		FACILITY NUMBER:	280111959
ADMINISTRATOR:	GANTAN, KAM		FACILITY TYPE:	740
ADDRESS:	115 THAYER WAY		TELEPHONE:	(707) 558-8487
CITY:	AMERICAN CANYON	STATE: CA	ZIP CODE:	94503
CAPACITY:	24	CENSUS: 22	DATE:	01/16/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Kam Gantan		TIME COMPLETED:	11:10 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

License was transfered inappropriately

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

At approximately 9:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegation. LPA met with Administrator Kam Gantan, Applicant Babita Dhawan and reviewed records. LPA reviewed application documents submitted by applicant. LPA observed Kam Gantan is not listed on the application as anything but Administrator. The applicant, Serene Care Home LLC, is the current management company put into place in 2023 during a court ordered receivership. Based on interviews conducted with Administrator and Applicant, the physical property was sold to Boda Properties LLC during the receivership in 2023. Kam Gantan has no financial involvement with Boda Properties or Serene Care Home LLC. At this time, the application is still pending and there has not been a transfer of the License.
This agency has investigated the above allegation. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 1