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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005239
Report Date: 03/01/2022
Date Signed: 03/01/2022 03:03:33 PM


Document Has Been Signed on 03/01/2022 03:03 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 ESTATESFACILITY NUMBER:
347005239
ADMINISTRATOR:CHRISTINA L. GARCIAFACILITY TYPE:
740
ADDRESS:7548 GREENHAVEN DRTELEPHONE:
(916) 427-8887
CITY:SACRAMENTOSTATE: CAZIP CODE:
95831
CAPACITY:105CENSUS: DATE:
03/01/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:TIME COMPLETED:
02:00 PM
NARRATIVE
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A Non-Compliance Conference was conducted on 1/25/2022 via Microsoft Teams with the Sacramento South Regional Office. At the request of the licensee a touch-base conference call is being conducted today on 3/1/2022. The purpose of this meeting is to discuss and review procedures put in place to ensure the facility remains in substantial compliance.

Present in the meeting is Regional Manager (RM) Krystall Moore, Licensing Program Manager (LPM) Stephenie Doub, Licensing Program Analyst (LPA) Victoria Brown, LPA Jamie Ivey Canady, Representatives of FC Ranger OPS Greenhaven Estates: Stephanie Hamner, Managing Director, Investments at Formation Capital, Cory Bennett, Senior Vice President, Investments at Formation Capital, Kristen Bennett, Senior Vice President, Wellness Portfolio Management at DigitalBridge; Representatives of GH Senior Living: Gregory Roderick President and CEO at Frontier Management, Matthew Dunham, Executive Vice President at Frontier Management, Kandice Alcorn, Vice President of Clinical Services at Frontier Management, Rickay Hidalgo, Vice President of Operations at Frontier Management, Joel S. Goldman, Hanson Bridgett-Regulatory and Licensing Counsel for Greenhaven Estates, Christina Luna Garcia, Administrator of Record at Greenhaven Estates.

The Non-Compliance Conference process was explained during the meeting on 1/25/2022 at which time a Non-Compliance Conference Summary (LIC 9111) was generated to document the office meeting.
A copy of the LIC809 report and the LIC 9111 was provided.

See 809C for continuation...
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Jamie Ivey-CanadyTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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
VISIT DATE: 03/01/2022
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809 Continued

Issues discussed during the meeting were:
· Change of Administrator Update
· Technical Support Program Update
· Medication Training/errors and consultant feedback implementation
· Weekly Report to be submitted
· Staffing
· Reporting Requirements-Late Covid Results
The facility has stated they will do the following to achieve continued and substantial compliance:
· Monitoring of reportable incidents and ensuring LIC624 is sent to CDSS on time
· Technical support program to be scheduled

· Administrator recruitment pending

· Medication Training/errors and consultant documentation to be updated


· Labs to contact facility with any covid positives

· Submit all audits within 5 days of completion per stipulation


· Covid positive line list to be submitted before noon until 2 rounds of negative tests have been completed

CCLD will do the following:


· Increase monitoring

On 1/25/2022, the facility was advised that completing a Non-Compliance Conference does not deprive the Department of its authority to take appropriate formal legal action under the Health and Safety Code if such action is deemed necessary by the Regional Manager. The licensee has requested an additional touch base conference to be held in May of 2022. The Department will re-evaluate compliance before referring this case to Legal for Administrative Action.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit. An exit interview was conducted via Microsoft Teams and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Jamie Ivey-CanadyTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022
LIC809 (FAS) - (06/04)
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