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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700474
Report Date: 02/20/2025
Date Signed: 02/20/2025 10:14:33 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
10/16/2024 and conducted by Evaluator Kevin Gould
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20241016095558
FACILITY NAME:GREENHAVEN PLACE INDEPENDENT LVG AND ASSISTED LVGFACILITY NUMBER:
342700474
ADMINISTRATOR:BRITTANY A ANDREWSFACILITY TYPE:
740
ADDRESS:6350 RIVERSIDE BLVDTELEPHONE:
(916) 427-1133
CITY:SACRAMENTOSTATE: CAZIP CODE:
95831
CAPACITY:48CENSUS: 37DATE:
02/20/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Brittany AndrewsTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Sexual Abuse: Staff member sexually assaulted resident.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Kevin Gould and Cynthia Tamayo made an unannounced inspection to the Greenhaven Place RCFE on 2/20/25 at 9:00am to conclude the investigation of the above allegation and to deliver the findings. LPAs met with administrator, Brittany Andrews and together discussed the investigation details.

Based on the interviews conducted during the investigation process and statements obtained during the investigation process, the department was unable to corroborate the allegations. The department obtained records for the alleged victim R1 (see confidential name list LIC-811 dated 2/20/25) including but not limited to Personnel Report (LIC 500), Current Client Roster, Incident report dated 10/11/24, admission agreement, face sheet ID information, Physician's report (LIC-602), pre placement appraisal, Mini cog dated 3/19/24, fall risk assessment, needs and services plan (initial and most recent), MARS from September and October 2024. Report Continued on LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
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 2
Control Number 27-AS-20241016095558
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GREENHAVEN PLACE INDEPENDENT LVG AND ASSISTED LVG
FACILITY NUMBER: 342700474
VISIT DATE: 02/20/2025
NARRATIVE
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Additionally the department conducted interviews with alleged victim, R1 who expressed confusion, disorientation of time and place and the reason for her most recent hospitalization. R1 did not provide any substantive statements to the department and refused to discuss the allegations. The department conducted interviews with three other residents and five staff members. All parties interviewed denied ever witnessing any inappropriate behaviors by staff members or other residents.

A forensic examination of R1 was conducted and the results of the examination found no evidence of sexual assault. The department also obtained a written statement from caregiver S1, who matched the description of the alleged abuser, stating they were not at work on the days the allegation allegedly took place and provided written statements that R1 would often refuse care from the staff member S1 and preferred assistance from female staff members. S1 denied the allegations.

Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of Sexual Abuse are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed.

There are no deficiencies is cited per California Code of Regulations, TITLE 22.

Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2