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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390312809
Report Date: 01/31/2025
Date Signed: 02/04/2025 09:10:28 AM

Document Has Been Signed on 02/04/2025 09:10 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/
DIRECTOR:		JOSE VENTURAFACILITY TYPE:
740
ADDRESS:368 S. WILMA AVE.TELEPHONE:
(209) 599-7670
CITY:RIPONSTATE: CAZIP CODE:
95366
CAPACITY: 59TOTAL ENROLLED CHILDREN: 0CENSUS: 42DATE:
01/31/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Jose VenturaTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Unannounced annual visit made out to this facility on 01/31/2025 by Licensing Program Analyst (LPA) Charlie Yang and Regional Manager (RM) Stephenie Doub who was met by the facility designated Administrator, Jose Ventura, who was briefly interviewed. It was learned that there were residents under the care of hospice at this time while other residents were receiving services through home health as well.
This facility does have a hospice waiver approved for (5) residents and a program, on file, for dementia care unto the residents at any given time.
Current census was 42 residents, of which, 26 were in the Assisted Living building (Building A). The other 16 residents, of which (8) were living in Building B and another (8) in Building C were considered as Memory Care.
A tour of this facility was conducted alongside the facility designated Administrator Jose Ventura.
Administrator certificate was observed to be present and in compliance at this time for facility designated Administrator Jose Ventura.
Kitchen area was toured. Cabinets and drawers were reviewed. Food preparation stations, dishwashing station, and other areas intended for meal preps were toured.
Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. This LPA did observe additional food storage units which were present and functional at this time.
A tour of the dining area, living area, and all other areas intended for resident use was conducted.
Medication rooms, located in each building, were reviewed. Policies and procedures involving dispensing, documenting, and overall administration of resident medications were discussed with the facility designated medication technicians at this time. The medication carts were observed to be locked and made inaccessible to the residents at this time.
A tour of the resident bedrooms and restroom was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. It was learned that there were only private and semi-private living arrangements for residents on the Assisted Living portion of this facility.
Hot water temperatures were taken and measured to make sure that they were within the allowed range of
Liza KingTELEPHONE: (650) 676-0442
Charlie YangTELEPHONE: (916) 709-6507
DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2025
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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: BETH HAVEN
FACILITY NUMBER: 390312809
VISIT DATE: 01/31/2025
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105-120 degrees.
Linen closet, located in the facility laundry area, was observed to contain a sufficient supply of towels, blankets, and linens to meet the needs of the residents at this time.
A tour of the Memory Care buildings, Building B and C, was conducted.
Fire extinguishers, located throughout this facility, were observed to have been annually inspected on 05/06/2024 by the local fire extinguisher company, Cisco Fire Sprinklers Inc., and in compliance at this time.
First aid kits were observed to be present and contained all of the required components at this time.
Exterior grounds of this facility were toured. A review of the facility perimeter fence, side gates, and exits was conducted.

A review of (10) facility resident files was conducted and noted on the following LIC 858.
A review of (10) facility personnel files was conducted and noted on the following LIC 859.

The following forms and documents were requested to be updated and submitted into CCL:
  • LIC 308

  • LIC 400

  • LIC 500

  • LIC 610


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

Exit Interview
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Charlie YangTELEPHONE: (916) 709-6507
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025
LIC809 (FAS) - (06/04)
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