347005239-9-7-2023-27-AS-SRIN-CYXSFP-20231228125041

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005239
Report Date: 09/07/2023
Date Signed: 09/07/2023 03:44:43 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/05/2023 and conducted by Evaluator Victoria Brown

COMPLAINT CONTROL NUMBER: 27-AS-20230905100849

FACILITY NAME:	GREENHAVEN ESTATES		FACILITY NUMBER:	347005239
ADMINISTRATOR:	BENJI DOCTOLERO		FACILITY TYPE:	740
ADDRESS:	7548 GREENHAVEN DR		TELEPHONE:	(916) 427-8887
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95831
CAPACITY:	105	CENSUS: 51	DATE:	09/07/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Benji Doctolero		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff do not respond to residents’ call buttons in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 9/7/23 at 8:30am to conduct an investigation of the above mentioned allegation. LPA met with Administrator Benji Doctolero and stated the purpose of the visit. LPA interviewed the adminitrator and staff and residents during this visit. LPA received a list of staff with contact information and residents with room numbers, staffing schedule for each work shift, and list of staff who has been laid off for any reason.

During this visit, LPA joined a meeting held by 3 members of the resident council, as well as the Long Term Care Ombudsman (LTCO) regarding the call button response time and staffing. LPA observed that the Administrator was explaining the purpose of the laid offs which should not affect the care and supervision of the residents. LPA observed that residents want to be reassured that staff are not rushed when providing care.

Unfounded

Estimated Days of Completion: 30

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

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-20230905100849

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 09/07/2023

NARRATIVE

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The investigation revealed that residents are not happy that so many staff were laid off due to the current census of the facility. The complaint was called into Community Care Licensing (CCL) not due to a care and supervision issue.

R1 is independent and self sufficient with Activities of Daily Living (ADLs). However, after smoking, during the day and night, R1 wants staff to push the wheel chair from the courtyard into the building even though R1 can do it alone. R1 stated this assistance was being done when the facility had 3 caregivers and 1 medication technician on duty.

Based on interviews and observation, the allegation is deemed UNFOUNDED.

The allegation is UNFOUNDED, meaning that the allegation was false, could not have happened and/or was without a reasonable basis. This Department has therefore dismissed the complaint.

Per California Code of Regulations, no deficiencies were observed or cited.

Exit interview held, and a copy provided.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

LIC9099 (FAS) - (06/04)

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