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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
347005239
Report Date:
07/29/2021
Date Signed:
07/29/2021 11:42:09 AM
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 ESTATES
FACILITY NUMBER:
347005239
ADMINISTRATOR:
DONNA BAUTISTA-COLMENARES
FACILITY TYPE:
740
ADDRESS:
7548 GREENHAVEN DR
TELEPHONE:
(916) 427-8887
CITY:
SACRAMENTO
STATE:
CA
ZIP CODE:
95831
CAPACITY:
105
CENSUS:
52
DATE:
07/29/2021
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
09:30 AM
MET WITH:
Luna Garcia
TIME COMPLETED:
12:00 PM
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THIS REPORT AMENDS THE CASE MANAGEMENT REPORT DATED 7/21/21. LPA INADVERTENTLY INPUT THE INCORRECT VISIT DATE IN THE BODY OF THE REPORT AND WILL ASSESS CIVIL PENALTIES FOR THE REPEAT VIOLATION.
SUPERVISOR'S NAME:
Stephen Richardson
TELEPHONE:
(916) 263-4746
LICENSING EVALUATOR NAME:
Victoria Brown
TELEPHONE:
(209) 814-1955
LICENSING EVALUATOR SIGNATURE:
DATE:
07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/29/2021
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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