197605522-11-2-2021-29-AS-JAPL-C8KUCP-20211108142812

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197605522
Report Date: 11/02/2021
Date Signed: 11/02/2021 04:51:44 PM

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
09/17/2021 and conducted by Evaluator Salia Walker

COMPLAINT CONTROL NUMBER: 29-AS-20210917141855

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:	6	CENSUS: 4	DATE:	11/02/2021
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Sandra Arreglado, Designee		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility has pests

INVESTIGATION FINDINGS:

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This is an addendum report to the report issued on 10/19/2021, regarding the allegation, ‘Facility has pests’ as the LPA will be providing additional details in this report to illuminate and clarify what was completed during the investigation. The complainant’s concern was that they saw a lot of spider webs at the facility and there was allegedly a black widow outside Resident #1’s (R1’s) window. The complainant also had concerns that the window did not close all the way and that the black widow or any spider would be able to get inside the facility.

The LPA is making this subsequent visit to further elaborate on the physical plant tour that was conducted on 09/22/2021 and 10/19/2021. In addition, the LPA will conduct an additional physical plant tour today.

Continue on LIC9099C..

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2021

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 29-AS-20210917141855

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: A HEAVENLY HAVEN, INC.	FACILITY NUMBER: 197605522
	VISIT DATE: 11/02/2021

NARRATIVE

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On 09/22/2021, LPA Walker conducted an initial complaint visit. The LPA conducted a physical plant tour at 10:05 a.m. The physical plant tour consisted of a thorough inspection of the facility inside and outside by the LPA. The LPA inspected all resident bedrooms, facility bathrooms, facility kitchen, facility living rooms, facility dining room, facility garage, and the facility backyard.
In the resident bedrooms, the LPA had the administrator move furniture away from the walls to see if any spider webs/ spiders were hiding behind the furniture. The LPA also, had the administrator open closet doors, drawers, and window blinds. The LPA inspected underneath all resident beds, and behind the bed areas to ensure no spider webs/spiders were hiding in these spaces. The LPA also inspected corner areas in the ceiling of the resident bedrooms, as well as, behind the televisions. The LPA inspected all resident bedroom windows, and all the window screenings, which were properly fitted and sealed. Upon the LPA inspecting the window screenings, the LPA observed them to have no access for insects to enter. No spider webs or spider were found in the resident bedrooms. In the facility bathrooms, the LPA inspected behind shower curtains, behind the toilets, and the bathroom window in bathroom #1. The LPA also had the administrator unlock and open all cabinets under the sinks in the facility bathrooms. The LPA inspected corner areas of the ceiling in the bathrooms. No spider webs or spider were found in the facility bathrooms. In the facility kitchen, the LPA asked the administrator to unlock and open all kitchen cabinets and drawers to ensure no webs or spider were in these areas. The LPA asked the administrator to move the microwave, blender, and all other appliances away from the wall to ensure no spider webs/ spiders were hiding in these areas. The LPA also checked under the facility sink. The LPA also inspected the kitchen window for any spider webs/ spiders. No spider webs or spider were found in the facility kitchen. In the facility living rooms, the LPA inspected behind the couches, televisions, book shelfs, and under the tables. No spider webs or spider were found in the facility living rooms. In the facility dining room, the LPA asked the administrator and staff to move the dining table, and couch. The LPA inspected the windows in the dining room, and all the window screenings, which were properly fitted and sealed. Upon the LPA inspecting the window screenings, the LPA observed them to have no access for insects to enter. No spider webs or spider were found in the resident bedrooms.
The LPA and administrator continued to conduct the physical plant outside of the facility as well. The LPA inspected the facility garage which is detached from the home. The LPA asked the administrator to open the door, and both the LPA and administrator went inside. The LPA inspected the facility garage roof, shelfs, and behind boxes. No spider webs or spiders were visible in the garage.

Continue on LIC 9099C..

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2021

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20210917141855

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: A HEAVENLY HAVEN, INC.	FACILITY NUMBER: 197605522
	VISIT DATE: 11/02/2021

NARRATIVE

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Upon touring the facility’s backyard, the LPA did observe spider webs near the plants, bushes, and trees. Although the LPA observed some spider webs along the outside of the facility wall from the bushes near the outside seating area, when the LPA inspected all the windows and window screenings from the outside, they were properly fitted and sealed. The LPA did not observe the windows or window screening to have any access for insects to enter. No spiders were observed near the windows of the facility, nor on the walls of the facility. The LPA observed one (1) spider in the backyard on a web made in a bush not connected to the facility. The bush was on the fence dividing the next property.
From 11:28 a.m. until 11:48 a.m., the LPA conducted interviews with family members of residents living at the facility. From 11:50 a.m. until 12:30 p.m., the LPA reviewed and obtained copies of documents pertinent to the investigation.
On 10/19/2021, LPA Walker conducted an unannounced subsequent complaint visit to deliver the investigation finding for the above allegations. The LPA met with administrator Francisca Recede at 12:35 p.m. and explained the reason for the visit. During the visit, the LPA conducted a second thorough physical plant tour at 1:30 p.m. to ensure there are no health and safety hazards. The LPA did not find any spider webs/ spiders inside the facility. The LPA inspected the facility backyard as well, and no spider webs/ spiders were observed on the outside of the facility.
During today’s visit, the LPA conducted a third thorough physical plant tour. The LPA physically looked at all the windows on the inside of the facility and the outside of the facility. The LPA inspected all windows, and all the window screenings, which were properly fitted and sealed. Upon the LPA inspecting the window screenings, the LPA observed them to have no access for insects to enter. No spider webs or spider were found in the resident bedrooms.
The complainant had sent photos as to what was reported to have been a spider on the window; however, there was insufficient evidence to verify it was actually a spider.
Furthermore, upon the LPA inspecting the facility windows and window screenings and conducting a third physical plant tour, the LPA did not observe any spider webs or spiders inside the facility. The LPA did not observe the windows or window screenings to have access for insects to enter. Therefore, based on LPA’s observation, there is insufficient evidence to support the allegation ‘Facility has pests.’ This allegation remains as Unsubstantiated at this time.

Exit interview conducted, a copy of the report was provided.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2021

LIC9099 (FAS) - (06/04)

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