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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700469
Report Date: 07/09/2026
Date Signed: 07/09/2026 02:02:41 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
06/10/2026 and conducted by Evaluator Cassandra Mikkelson
COMPLAINT CONTROL NUMBER: 59-AS-20260610082532
FACILITY NAME:GREAT HAVENFACILITY NUMBER:
342700469
ADMINISTRATOR:EZE, CHINYEREFACILITY TYPE:
740
ADDRESS:71 GROTH CIRTELEPHONE:
(916) 833-6388
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY:6CENSUS: 6DATE:
07/09/2026
UNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Gift EzeTIME COMPLETED:
02:10 PM
ALLEGATION(S):
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Facility has hot water issues
Licensee didn't notify people of the hot water issue
INVESTIGATION FINDINGS:
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Licensed Program Analyst (LPA) Cassandra Mikkelson arrived unannounced and met with Administrator Gift Eze to deliver findings for the above complaint allegation. LPA met Licensee at the temporary facility while the hot water is being fixed at the facility.

During the investigation, LPA conducted interviews, conducted a tour of the facility, and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

*** Report continued on 9099-C***
Substantiated
Estimated Days of Completion: 10
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 59-AS-20260610082532
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GREAT HAVEN
FACILITY NUMBER: 342700469
VISIT DATE: 07/09/2026
NARRATIVE
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Facility has hot water issues

Interviews conducted with Licensee indicated that the facility has been without hot water since the middle of May 2026 due to a broken/leaking pipe in one of the showers. During a visit conducted on 06/10/2026, the hot water issue had not been resolved at this time due to the pipes in the home needing to be replaced. The facility is currently warming water on the stove for showers and cleaning. The Licensee has been working with Sacramento County to get contractors scheduled to get the hot water issue resolved. Therefore, the allegation facility has hot water issues is substantiated.

Licensee didn't notify people of the hot water issue

Interviews conducted with the Licensee indicated that Community Care Licensing (CCL) was not notified of the hot water issue in the home. The Licensee has been in contact with Sacramento County to get the hot water issues resolved but did not inform CCL when the issue first arose. Therefore, the allegation licensee didn’t notify people of the hot water issue is substantiated.

Based on the information obtained for the allegations above, the allegations are SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Exit interview conducted with Executive Director and a copy of the report and appeal rights was provided.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20260610082532
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GREAT HAVEN
FACILITY NUMBER: 342700469
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/23/2026
Section Cited
CCR
87211(a)(2)
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87211 Reporting Requirements
(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:
(2) Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate.
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Licensee will write a plan of how and when to report incidents to CCLD by POC due date.
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This was not met by evidenced by:
Licensee did not inform CCLD of hot water issue at the facility.
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Type B
07/23/2026
Section Cited
CCR
87303(e)(2)
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87303 Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C).
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Licensee is having water pipes fixed/replaced in the home currently. No POC will be due for this citation.
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This was not met by evidenced by:
Hot water pipes were not working/hot water not availabel to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3