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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209068
Report Date: 12/20/2022
Date Signed: 12/20/2022 12:25:41 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/13/2022 and conducted by Evaluator Melinda Medina
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20221213160510
FACILITY NAME:HIGH DESERT HAVENFACILITY NUMBER:
157209068
ADMINISTRATOR:MATHEW, ABRAHAMFACILITY TYPE:
740
ADDRESS:1240 COLLEGE HEIGHTS BLVDTELEPHONE:
(760) 371-1989
CITY:RIDGECRESTSTATE: CAZIP CODE:
93555
CAPACITY:82CENSUS: 73DATE:
12/20/2022
UNANNOUNCEDTIME BEGAN:
11:01 AM
MET WITH:Carolyn Storruste, Residential Care CoordinatorTIME COMPLETED:
12:42 PM
ALLEGATION(S):
1
2
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5
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8
9
Facility staff unlawfully evicted resident
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
11
12
13
On 12/20/22, Licensing Program Manager (LPM) M. Hoffmann and Licensing Program Analyst (LPA) M. Medina arrived to conduct an initial 10-day complaint visit.

LPA Medina conducted interviews and reviewed resident (R1) records during complaint investigation. During investigation interviews, it was found that R1 had been transferred to the hospital for an emergency and upon release facility was requesting a re-assessment prior to returning to facility to ensure that R1 needs could be met by facility staff. R1 was re-assessed by primary physician and released to return to facility on 12/15/22 and placed on Hospice services that same day.

This Department investigated the complaint alleging facility staff unlawfully evicted resident. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

No deficiencies cited during complaint investigation.

An exit interview was conducted. A copy of this report will be provided to facility for facility records via e-mail due to issues with printer.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
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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