342700474-3-8-2024-27-AS-KHOS-D3HJZZ-20240319073021

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700474
Report Date: 03/08/2024
Date Signed: 03/08/2024 12:07:10 PM

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
10/13/2023 and conducted by Evaluator Kevin Gould

COMPLAINT CONTROL NUMBER: 27-AS-20231013091842

FACILITY NAME:	GREENHAVEN PLACE INDEPENDENT LVG AND ASSISTED LVG		FACILITY NUMBER:	342700474
ADMINISTRATOR:	BRITTANY A ANDREWS		FACILITY TYPE:	740
ADDRESS:	6350 RIVERSIDE BLVD		TELEPHONE:	(916) 427-1133
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95831
CAPACITY:	48	CENSUS:	DATE:	03/08/2024
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Morgan Whinery		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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1) Facility does not provide itemized billing statements.
2) Staff do not take resident's vitals as per care plan.
3) Facility does not have an administrator on the premises a sufficient number of hours.
4) Unlocked door presents a safety hazard.
5) Facility was unable to provide power during a power outage.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Kevin Gould made an announced inspection to the Greenhaven Place Independent and Assisted Living on 3/8/24 at 9:15am to conclude the investigation of the above allegations and to deliver the findings. LPA Gould met with administrator, Morgan Whinery and together discussed the investigation details.

Based on the interviews conducted during the investigation process and statements obtained during the investigation process, LPA Gould was unable to corroborate the allegations. LPA reviewed resident's records and including billing statements from October 2023 to present. LPA reviewed resident evaluation and corresponding levels of care fees that were provided to LPA and available to all residents and authorized representatives. LPA and department have determined the documentation met all title 22 regulations for billing requirements and development process for evaluating levels of care. the allegation regarding billing statements have determined to be unsubstantiated. As apart of the review process LPA did not observe any written agreements for daily vitals documentation or observed any billing for said services. Report Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Kevin Gould	TELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

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 27-AS-20231013091842

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: 03/08/2024

NARRATIVE

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Staff interviewed provided statements to LPA that a vitals program was considered but never implemented and no resident was ever charged for the service. LPA observed no physician's request for documentation of daily vitals.

LPA reviewed staff records and did observe that there was an administrator or their designated substitute present at the facility for the amount of hours needed to meet the needs of residents. LPA observed that the designated substitute also obtained administrator certification and was present at the facility in the administrators absence.

Regarding the allegations of unlocked doors. the facility's approved plan of operation does not indicate the facility will lock all exterior doors. Based on interviews conducted at the facility the identified doors are only unlocked from 8am to 5pm and there have been no reported issues with unauthorized individuals entering the facility or the unlocked doors posing a danger to residents. This facility does not have a memory care program.

LPA reviewed records that could not corroborate a specific power outage as the reporting party could not provide specifics in terms of exact dates/times. Per the complaint and title 22 regulations there is no requirement that the facility maintain power at all times only that there be an emergency plan of operation and if the plan was implemented. staff interviewed were able to describe emergency plan of operation and actions taken in a power outage. There are no requirements for the facility to have a backup power generator. Per the reporting party the power outage was minimal and power restored in a few hours.

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 Physical Plant and Other 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 the licensee. Appeal Rights were issued, and a copy of this report was left at the home.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Kevin Gould	TELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

LIC9099 (FAS) - (06/04)

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