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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700449
Report Date: 11/22/2021
Date Signed: 11/22/2021 02:21:45 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:GREENHAVEN BLISSFUL HOMEFACILITY NUMBER:
342700449
ADMINISTRATOR:TORRES, CHRISTINEFACILITY TYPE:
740
ADDRESS:6200 FENNWOOD CTTELEPHONE:
(916) 753-7564
CITY:SACRAMENTOSTATE: CAZIP CODE:
95831
CAPACITY:6CENSUS: 6DATE:
11/22/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:TIME COMPLETED:
01:30 PM
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An Office Meeting was held today in the Sacramento South Adult and Senior Care Regional Office via Microsoft Teams. This meeting was held due to the partnership change in the entity of Greenhaven Blissful Home LLC. Those present in the meeting are Licensing Program Manager (LPM) Stephen Richardson, Licensing Program Analyst (LPA) Victoria Brown, Co-Licensee(s) Lilia Vergara, Christine Torres, and Erwin Torres of Greenhaven Blissful Home LLC, along with additional LLC members Rosario Sivila. Co-Member Glenn Sivila was not able to attend this meeting.

In May 7, 2021, Co-Licensee Lilia Vergara sold her 50% interest in the entity and the home to Rosario Sivila and Glenn Sivila.

LPA submitted an inquiry with the Central Application Bureau (CAB) to confirm receipt of a Change of Ownership (CHOW) application for this address. To date, there is no pending application on file with the Department.
A business search revealed that 5/7/21, Rosario Sivila and Glenn Sivila were added to the LLC and Lilia Vergara had been removed. Currently, Christine Torres, Edwin Torres, Rosario Sivila, and Glenn Sivila are co-member(s) of the LLC. Rosario Sivila, and Glenn Sivila has Control of Property with a lease agreement with the LLC. Christine Torres, and Edwin Torres stated there are no changes to the operations of the facility or the finances.

To remain in substantial compliance Christine Torres agreed to submit the following:
-A copy of the Change of Ownership Application Part A & B-to be submitted by 11/22/21 to Regional Office along with receipt of payment and updated Secretary of State documents (Original mailed to Program Office on 9/8/21)
-A copy of the letter to each resident and/or responsible party regarding the intent

All parties were advised that should anything discussed change, Community Care Licensing (CCL) will be contacted immediately to ensure continued health and safety of the residents. Also, if there are any concerns or questions to contact LPA Victoria Brown.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit. An exit interview was conducted with Christine Torres via telephone and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria BrownTELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2021
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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