390312809-4-29-2025-27-AS-LKIG-DG8MTM-20250430095343

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 390312809
Report Date: 04/28/2025
Date Signed: 04/29/2025 09:45:24 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/11/2025 and conducted by Evaluator Charlie Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20250311123231

FACILITY NAME:	BETH HAVEN		FACILITY NUMBER:	390312809
ADMINISTRATOR:	JOSE VENTURA		FACILITY TYPE:	740
ADDRESS:	368 S. WILMA AVE.		TELEPHONE:	(209) 599-7670
CITY:	RIPON	STATE: CA	ZIP CODE:	95366
CAPACITY:	59	CENSUS: 44	DATE:	04/28/2025
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Jose Ventura		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff did not ensure that resident was treated with dignity and respect

Staff falsified incident report

Staff speak inappropriately to residents

Staff do not ensure that resident's medication is refilled in a timely manner

INVESTIGATION FINDINGS:

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Unannounced complaint visit made out to this facility on 04/28/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Jose Ventura, who was briefly interviewed at this time.
Current census was 44 residents.
The purpose of this visit was to deliver the findings of this investigation to this facility, and it's designated Administrator, at this time.
Based on interviews conducted during the course of this investigation, it was learned that R1 has been a resident at this facility for over a year. It was learned that basic care and supervision was provided to R1 as outlined in their plan of care since R1's admission to this facility.
Based on interviews, it was learned that there was an incident that took place at this facility involving R1 and R1's family member. During this incident, it was learned that R1 and R1's family member got into a verbal argument resulting in the family member leaving R1's room seeking the counsel of the facility designated Administrator who was present at the time of this incident. It was learned that the facility designated

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20250311123231

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 04/28/2025

NARRATIVE

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Administrator was not directly present in the resident room when the incident took place but did respond and was present to intervene and did overhear the loud voices and strained conversation at that time.
It was learned that the police were called and were present to look into this matter since physical violence was alleged at that time. Based on a review of the forms and documents conducted, it was learned that law enforcement did not have sufficient evidence to support the allegations of physical violence and did not take any further actions against any parties that were present during the time of this incident. In addition, law enforcement did not find any evidence that violations were being carried out against the personal rights and dignity of any facility residents at that time. It was learned that law enforcement did not find any evidence that any person, staff or family member, were speaking in a tone or manner which was deemed to be inappropriate at that time.
Based on a review of the facility forms and documents, it was learned that the incident reports were filled out and contained all of the required details in relation to this incident which took place in the early part of January 2025. This information was compared to the testimonies of all persons who were present at that time and it was observed to conform to their accounts of the events that took place at that time.
Based on a review of the facility medication administration records, it was learned that the medications for R1 were being properly ordered, documented, and dispensed at this time.
Based on interviews conducted, it was learned that persons close to R1 felt that this facility was doing their best to meet the demands for R1 even though they felt that it was challenging at times. It was learned that these persons were content with the care and supervision that was being provided to R1 at this time and did not have any complaints.

As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegations finding of Unsubstantiated meant that although the allegations may have happened or were valid, there was not a preponderance of the evidence to prove that the alleged violations occurred.

There were no deficiencies observed or cited at this time.

Exit Interview

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025

LIC9099 (FAS) - (06/04)

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