197605522-4-21-2023-29-AS-DPEA-CR93HU-20230425181631

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197605522
Report Date: 04/21/2023
Date Signed: 04/21/2023 04:04:31 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/12/2021 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20211012091307

FACILITY NAME:	A HEAVENLY HAVEN, INC.		FACILITY NUMBER:	197605522
ADMINISTRATOR:	FRANCISCA M. RECEDE		FACILITY TYPE:	740
ADDRESS:	5504 FALLBROOK AVENUE		TELEPHONE:	(818) 713-0447
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY:	0	CENSUS: 0	DATE:	04/21/2023
		UNANNOUNCED	TIME BEGAN:	03:04 PM
MET WITH:	Francisca Recede		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff are interrupting resident's visits
Staff are isolating resident during meals
Resident's dental hygiene needs are not being met while in care

INVESTIGATION FINDINGS:

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Due to the closure of the facility effective 01/20/2023, Licensing Program Analyst (LPA) initiated contact with former licensee Francisca Recede telephonically and reason for contact was explained. Final finding for the allegations above discussed with Ms. Recede. On 10/12/2021 the Department received a complaint with the above allegations. On 10/19/2021, LPA Walker conducted the initial complaint visit. From 12:30 p.m. until 1:30 p.m., LPA conducted interviews with facility staff, and the administrator. At 1:30 p.m., LPA conducted a physical plant tour. From 1:40 p.m. until 2:00 p.m., LPA reviewed, and obtained copies of documents pertinent to the investigation. Administrator and staff denied allegations. On 1/03/2022 interview was conducted with resident #1 (R1) and R1’s conservator. R1 and conservator reported being happy with the care and did not have any issues or concerns. No report of any unmet needs, isolation or visits being interrupted by staff. Additional interviews conducted on 1/03/2022 with potential witnesses expressed being satisfied with the care provided by facility staff and did not have any issues or concerns to report. Based on the above, there is not enough evidence to support allegations. Therefore, allegations are deemed Unsubstantiated at this time. Exit interview held, copy of report mailed certified to Ms. Recede's residence.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

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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