Greenhaven Blissful Home

Allegation investigated: Staff do not allow resident to visit with family Staff did not safeguard resident's personal belonging Staff do not allow resident to exit the facility

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 8/21/23 at 9:00a to conclude the investigation of the above mentioned allegations. LPA met with Christine Torres and stated the purpose of the visit. LPA conducted interviews of staff during this visit. Regarding allegation, "Staff do not allow resident to visit with family" LPA obtained information through interviews that resident #1 (R1) was allowed visitors on a daily basis and no one was ever denied visitation rights. LPA obtained a copy of the visitors log dated 8/11/21 - 4/5/23 which indicates famiy did not sign-in when visiting R1. However, LPA observed that R1 received visits from other persons during this time frame. Unfounded Regarding allegation, "Staff did not safeguard resident's personal belonging" LPA obtained information through interviews that R1 would not allow staff in the room to assist with locating the missing cell phones. Per R2, R1 would only use the facility phone when making calls. LPA observed while cleaning R1's room, S5 located 3 cell phones. Regarding allegation, "Staff do not allow resident to exit the facility" LPA did not observe through interviews an instance where resident was not allowed to leave the facility. Based on interviews and observation, the allegations are deemed UNFOUNDED. The allegations are 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.the state’s words, verbatim · CDSS document, Aug 21, 2023 · control 27-AS-20230626092157

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 3/22/23 at 9:15am to conduct a Required - 1 Year inspection visit. LPA met with Judith Lanuza, Caregiver and explained the purpose of the visit. Caregiver contacted Administrator regarding todays visit. Hospice approved for 2 residents. There are 1 residents receiving hospice services during this visit. Licensing fees are current. The facility is licensed for a capacity of 6 residents. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed residents during this visit. LPA observed 2-day perishables and 7-day non-perishables. The temperature inside the facility was observed to be at 75*F which is within the required range of 68-85*F. The hot water temperature was measured at 115.4*F which is within the required range of 105-120*F. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, pull alarm system, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. Upon a file review the following items were discussed to be submitted with any changes annually: Designation of Facility Responsibility (LIC308), Administrative Organization (LIC309), current Liability Insurance, Personnel Report (LIC500), Current Control of Property, Administrator Certificate-Updated Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies cited. Exit interview held, copy of report giventhe state’s words, verbatim · CDSS document, Mar 22, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 5/6/22 at 1:20PM to conduct an annual inspection visit. LPA met with Judith Lanuza, Caregiver and explained the purpose of the visit. Caregiver contacted Administrator regarding todays visit. Hospice approved for 2 residents. There are 0 residents receiving hospice services during this visit. Licensing fees are current. Administrator certificate expires 10/23/22 for Christine Torres. The facility is licensed for a capacity of 6 residents. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed residents during this visit. LPA observed 2-day perishables and 7-day non-perishables. The temperature inside the facility was observed to be at 78*F which is within the required range of 68-85*F. The hot water temperature was measured at 109.4*F which is within the required range of 105-120*F. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, pull alarm system, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. Upon a file review the following items were discussed to be submitted with any changes annually: Designation of Facility Responsibility (LIC308), Administrative Organization (LIC309), current Liability Insurance, Personnel Report (LIC500), Administrator Certificate-Updated Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies cited. Exit interview held, copy of report giventhe state’s words, verbatim · CDSS document, May 6, 2022

Type of visit: Office

An Office Meeting was held today in the Sacramento South Adult and Senior Care Regional Office via Microsoft Teams. This meeting was held due to the partnership change in the entity of Greenhaven Blissful Home LLC. Those present in the meeting are Licensing Program Manager (LPM) Stephen Richardson, Licensing Program Analyst (LPA) Victoria Brown, Co-Licensee(s) Lilia Vergara, Christine Torres, and Erwin Torres of Greenhaven Blissful Home LLC, along with additional LLC members Rosario Sivila. Co-Member Glenn Sivila was not able to attend this meeting. In May 7, 2021, Co-Licensee Lilia Vergara sold her 50% interest in the entity and the home to Rosario Sivila and Glenn Sivila. LPA submitted an inquiry with the Central Application Bureau (CAB) to confirm receipt of a Change of Ownership (CHOW) application for this address. To date, there is no pending application on file with the Department. A business search revealed that 5/7/21, Rosario Sivila and Glenn Sivila were added to the LLC and Lilia Vergara had been removed. Currently, Christine Torres, Edwin Torres, Rosario Sivila, and Glenn Sivila are co-member(s) of the LLC. Rosario Sivila, and Glenn Sivila has Control of Property with a lease agreement with the LLC. Christine Torres, and Edwin Torres stated there are no changes to the operations of the facility or the finances. To remain in substantial compliance Christine Torres agreed to submit the following: -A copy of the Change of Ownership Application Part A & B-to be submitted by 11/22/21 to Regional Office along with receipt of payment and updated Secretary of State documents (Original mailed to Program Office on 9/8/21) -A copy of the letter to each resident and/or responsible party regarding the intent All parties were advised that should anything discussed change, Community Care Licensing (CCL) will be contacted immediately to ensure continued health and safety of the residents. Also, if there are any concerns or questions to contact LPA Victoria Brown. 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 with Christine Torres via telephone and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.the state’s words, verbatim · CDSS document, Nov 22, 2021