Inspection visit

ComplaintSeptember 28, 2021

GREENHAVEN PLACE INDEPENDENT LVG AND ASSISTED LVGLicense 3427004743 citations on this visit

3 citations recorded

Inspector’s narrative

What the inspector wrote

In regards to the allegation, "Staff did not prevent a resident from wandering", LPA received a call from the Administrator and an Incident Report stating that R1 had eloped from the facility. At 8pm R1 was seen by the police who contacted the facility to identify R1. R1 sustained no apparent inuries but was confused. A review of R1's Physician Report dated 12/4/2020 revealed that R1 was diagnosed with Mild Cognitive Impairment (MCI), confused at times due to diagnosis of Parkinsins and unable to leave the facility unassisted. LPA also received a copy of the call log from Sacramento Police Department indicating that on 4/12/21, R1 was located and returned to the facility. Allegation deemed SUBSTANTIATED In regards to the allegation, "Staff did not properly report an incident involving a resident while in care", LPA obtained information that the responsible party requested a copy of any changes for R1, medication records and documentation of incidents where R1 was exit seeking, the documents were not provided. Allegation deemed SUBSTANTIATED Based on documentation the preponderance of evidence standards has been met; therefore, the above allegation(s) is found to be SUBSTANTIATED. A finding that the complaint allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are being cited on the attached 9099D during this visit. If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed. The Administrator was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights. An exit interview was conducted, a copy of the report was given.

Citations

3 citations recorded^*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

87465(d)(1Type A
Incidental Medical and Dental CareIf the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration provided all of the following requirements are met: Facility staff shall contact the resident's physician prior to each dose, describe the resident's symptoms, and receive direction to assist the resident in self-administration of that dose of medication. The date and time of each contact with the physician, and the physician's directions, shall be documented and maintained in the resident's facility record. The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. This requirement is not met as evidenced by: Facility documentation, R1 did not receive medication (s). timely. The Licensee did not refill medication or administer medications as prescribed. This possess an immediate health and safety risk to residents in care.
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87466Type A
Regular observation and documentation of resident changes
Observation of the ResidentThe licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Facility documentation, R1 was absent without leave (AWOL). The Licensee failed to adequately supervise R1 which allowed for R1’s elopement from the facility.This possess an immediate health and safety risk to residents in care.
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87468.1(a)(8)Type A
Regular representative updates on care
Personal Rights of Residents in All FacilitiesResidents in all residential care facilities for the elderly shall have all of the following personal rights: To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. This requirement is not met as evidenced by: R1's representative did not receive requested records. The Licensee failed to provide records for R1 as requested by representative.This possess an immediate health and safety risk to residents in care.

FAQ · About this visit

Common questions about this visit

What happened during the September 28, 2021 inspection of GREENHAVEN PLACE INDEPENDENT LVG AND ASSISTED LVG?

This was a complaint inspection of GREENHAVEN PLACE INDEPENDENT LVG AND ASSISTED LVG on September 28, 2021. 3 citations were issued: 3 Type A (serious).

Were any citations issued to GREENHAVEN PLACE INDEPENDENT LVG AND ASSISTED LVG on September 28, 2021?

Yes, 3 citations were issued (3 Type A, 0 Type B). The first citation was for: "Incidental Medical and Dental CareIf the resident is unable to determine his/her own need for a prescription or nonpresc..."

What type of inspection was this?

This was a complaint inspection. Complaint inspections are triggered when someone reports a concern about the facility to CCLD.

SourceView on CCLD View original report

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Data from CCLD public records. Last updated June 8, 2026. If you believe any information is inaccurate, report it here.

Complaint·September 28, 2021