342700469-12-3-2024-59-AS-LMUZ-DC9UTX-20241224145238

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700469
Report Date: 12/03/2024
Date Signed: 12/03/2024 04:29:28 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/07/2024 and conducted by Evaluator DeAnna Williams-Lyons

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20241007142235

FACILITY NAME:	GREAT HAVEN		FACILITY NUMBER:	342700469
ADMINISTRATOR:	EZE, CHINYERE		FACILITY TYPE:	740
ADDRESS:	71 GROTH CIR		TELEPHONE:	(916) 833-6388
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95834
CAPACITY:	6	CENSUS: 6	DATE:	12/03/2024
		UNANNOUNCED	TIME BEGAN:	02:32 PM
MET WITH:	Chinyere Eze, Licensee		TIME COMPLETED:	04:48 PM

ALLEGATION(S):

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Staff refused to accept resident back to the facility

INVESTIGATION FINDINGS:

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On December 3 2024, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to deliver findings for complaint # 59-AS-20241007142235. LPA met with Chinyere Eze, Licensee, and informed her the reason for the visit.

The Department received a complaint stating the facility refused to accept resident back from Hospital. During the investigation, the department interviewed facility staff and obtained pertinent documents relevant to the complaint investigation.

Licensee was interviewed and denied allegations. LPA also met with staff; residents, and placement agency. Special Incident Report history was reviewed. R1 had been leaving the facility with R1’s partner. Licensee noticed every time R1 would return, R1 would be acting different and aggressive with others in the facility. On one occasion, the police had to bring R1 back to the facility for inappropriate activity in public. Licensee had the police take R1 to the emergency room for an evaluation for drugs.

To continue see 9099-C...

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons	TELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024

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

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20241007142235

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GREAT HAVEN	FACILITY NUMBER: 342700469
	VISIT DATE: 12/03/2024

NARRATIVE

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R1 was admitted to the hospital for evaluation of the changes in R1s condition. The administrator informed licensing that R1 was sent back to the ER because R1 was still aggressive, not at her baseline, and the facility was concerned. The hospital tried to send her back to the facility after evaluation. The facility administrator asked that the resident go back to the hospital for further evaluation, due to extreme change in condition. Also, the facility wanted her evaluated to assess if she needs a higher level of care if needed.

R1 was told by staff that R1 could not return to the facility because there was no one there to assess R1 at that time. It was learned that R1 stayed at the hospital for an evaluation. LPA conducted interviews of staff and reviewed the facilities policy in regards to proper assessment of residents after being discharged from the hospital. It was learned that the facility did not acted appropriately in not allowing this resident to return to the facility without a proper reassessment from facility staff.

It appears that the facility did refuse the resident the right to return; they asked for further evaluation of her health condition; and evaluation to ascertain if a higher level of care was needed. The facility did not complete a re-assessment of R1 before R1 leaving the facility or at the time the hospital was ready to discharge.

Based on LPA’s observations, file reviews and interviews, the Department finds the complaint to be SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the preponderance of evidence standards has been met.

Per California Code of Regulations, Title 22, a citation was issued. Personal Rights 87468.1(2)

An exit interview was conducted, and a copy of this report was given to Chinyere.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons	TELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20241007142235

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GREAT HAVEN	FACILITY NUMBER: 342700469
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/03/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/03/2024 Section Cited CCR 87468	1 2 3 4 5 6 7	Personal Rights 87468.1(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. Licensee failed to accept a resident back from the hospital after evaluation. This is a personal rights violation as evidenced by	1 2 3 4 5 6 7	Licensee shall ensure resident is given an eviction notice once return from the hospital and noticed the care is beyond what the facility can provide. Even if the resident does not return to the facility..
	8 9 10 11 12 13 14	the residents housing was withheld when she was ready to be discharged from the hospital. No eviction notice was given.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons	TELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024

LIC9099 (FAS) - (06/04)

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