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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390312809
Report Date: 07/10/2024
Date Signed: 07/12/2024 10:00:51 AM


Document Has Been Signed on 07/12/2024 10:00 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:BETH HAVENFACILITY NUMBER:
390312809
ADMINISTRATOR:JOSE VENTURAFACILITY TYPE:
740
ADDRESS:368 S. WILMA AVE.TELEPHONE:
(209) 599-7670
CITY:RIPONSTATE: CAZIP CODE:
95366
CAPACITY:59CENSUS: 37DATE:
07/10/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Jose VenturaTIME COMPLETED:
03:30 PM
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Unannounced case management visit conducted on 07/10/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Jose Ventura.
A brief interview was conducted with the facility designated Administrator at this time.
Current census was 37 residents.
The purpose of this case management visit was to follow up, with quarterly visits, and inquire about the requirements that were laid out from the office meeting for the non compliance conference which took place on 03/04/2024.

The following items were required to be maintained in compliance while this facility was under increased monitoring with quarterly visits:
  • Maintain adequate facility staffing
  • Uphold all Personal Rights of the Residents
  • Maintain and conduct Personal Rights training and verification for new and existing employees
  • Facility designated Administrator must maintain oversight of facility staff for proper care and supervision
  • Make sure that this facility is following all Reporting Requirements
  • Updating policies and procedures for resident fall risks
  • Make sure that facility staff are always seeking timely medical attention
  • Update and maintain Needs/Appraisal Training for all staff
  • Maintain and train all care staff on proper documentation for the facility Communication Log


There were no deficiencies observed or cited during today's case management visit.

Exit Interview
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Charlie YangTELEPHONE: (916) 709-6507
LICENSING EVALUATOR SIGNATURE:
DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/10/2024
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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