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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502701433
Report Date: 07/10/2025
Date Signed: 07/10/2025 02:12:12 PM

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
03/05/2025 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20250305161401
FACILITY NAME:SAFE HAVEN OAKDALE LLCFACILITY NUMBER:
502701433
ADMINISTRATOR:GRIMESEY, AILEEN POQUIZFACILITY TYPE:
740
ADDRESS:2912 WESTPORT CIRCLETELEPHONE:
(510) 224-6165
CITY:OAKDALESTATE: CAZIP CODE:
95361
CAPACITY:6CENSUS: 4DATE:
07/10/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jamila Brodnax, House ManagerTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff mismanaged resident's medications.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 07/10/2025, Licensing Program Analyst (LPA) Renee Campbell went to the Safe Haven Oakdale LLC residential home for the elderly to deliver a complaint that was filed with the department on 3/5/2025:
Facility staff mismanaged residents’ medication

Based on a review of the MAR report and interview with S1, the allegation could not be substantiated as there was no indication that medication had been shared with another resident and S1 denied sharing a resident’s medication with other residents. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

There are no deficiencies noted or cited per California Code Regulation.
An exit interview was conducted with the House Manager Appeal Rights were issued, and a copy of this report was left at the facilit
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025
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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