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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700474
Report Date: 10/24/2022
Date Signed: 10/24/2022 04:01:42 PM


Document Has Been Signed on 10/24/2022 04:01 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:GREENHAVEN PLACE INDEPENDENT LVG AND ASSISTED LVGFACILITY NUMBER:
342700474
ADMINISTRATOR:ROBERT COEFACILITY TYPE:
740
ADDRESS:6350 RIVERSIDE BLVDTELEPHONE:
(916) 427-1133
CITY:SACRAMENTOSTATE: CAZIP CODE:
95831
CAPACITY:48CENSUS: 85DATE:
10/24/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Robert CoeTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 10/24/22 at 1:00p on a subsequent Case Management visit. LPA met with Robert Coe and stated the purpose of the visit. Community Care Licensing (CCL) received a incident report (LIC624) on 3/31/2022 regarding a resident stating that a caregiver was verbally aggressive while assisting with care needs. LPA obtained information that S2 is no longer working at the facility and the contact information has changed. LPA was unable to interview S2. S1 stated during this visit that S2 upon an investigation did not confirm or deny being verbally aggressive but admitted to being frustrated one night. After being pulled from the floor S2 resigned from working at the facility. R1 stated the caregiver no longer works for the facility and everyone is very helpful and that S2 was not feeling well that day.

Based on the information reviewed and obtained, although the allegation may have happened or is valid,
there is not a preponderance of the evidence to prove that the alleged abuse occurred and that the facility is at fault for any deficiencies regarding Title 22 regulations.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria BrownTELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2022
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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