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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005239
Report Date: 12/28/2021
Date Signed: 12/28/2021 03:57:24 PM

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 ESTATESFACILITY NUMBER:
347005239
ADMINISTRATOR:DONNA BAUTISTA-COLMENARESFACILITY TYPE:
740
ADDRESS:7548 GREENHAVEN DRTELEPHONE:
(916) 427-8887
CITY:SACRAMENTOSTATE: CAZIP CODE:
95831
CAPACITY:105CENSUS: 50DATE:
12/28/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Christina "Luna" GarciaTIME COMPLETED:
04:00 PM
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Licensing Program Analyst(s) Victoria Brown and Jamie Ivey Canady arrived unannounced to the facility on 12/28/21 at 3:00pm to conduct a Case Management visit. LPAs met with Christina "Luna" Garcia stated the purpose of the visit.

The Community Care Licensing (CCL) received notice that the Administrator Donna Bautista-Colmenares is no longer working at the facility. LPA also received a call fro Brian Pawloski, LVN Vice President of Operations for Northern California who stated that the Designee Christina "Luna" Garcia is in charge in the interim until the facility hires a new Executive Director.

LPAs observed the LIC308 Designation of Responsibility posted in the facility. LPAs received a copy of the current Administrator Certificate which expires 8/12/2023. The letter of Designation from Frontier Management indicated the wrong effective date of 12/22/22. The corrected letter and Certificate with the correct Administrator name shall be submitted to CCL.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit. Exit interview held with Christina Garcia. A copy of todays’ report provided.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria BrownTELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021
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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