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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 09:11:10 AM

Document Has Been Signed on 02/04/2025 09:11 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:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Jose VenturaTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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Unannounced case management visit conducted 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.
A brief interview was conducted with the facility designated Administrator at this time.
Current census was 42 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
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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