197606737-12-22-2021-31-AS-MVAO-CFVQME-20220630121725

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606737
Report Date: 12/22/2021
Date Signed: 12/22/2021 01:51:55 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., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/21/2021 and conducted by Evaluator Melissa Ruiz

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20211221112018

FACILITY NAME:	A HEAVENLY HAVEN, INC. II		FACILITY NUMBER:	197606737
ADMINISTRATOR:	FRANCISCA RECEDE		FACILITY TYPE:	740
ADDRESS:	20000 LASSEN STREET		TELEPHONE:	(818) 775-9397
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY:	6	CENSUS:	DATE:	12/22/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Francisca Recede		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Residents is not treated with dignity or respect
Resident is forced to fulfill duties of staff in the facility
Staff handled residents in a rough manner
Facility is not kept clean
Staff did not safeguard resident's personal items
Staff yelled at residents
Staff ignores resident call for assistance

INVESTIGATION FINDINGS:

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At 10:00 a.m., Licensing Program Analysts (LPA's) Melissa Ruiz and Angela Panushkina conducted an unannounced complaint visit to the facility mentioned above. LPAs were greeted by the Administrator Francisca Recede and explained the purpose for the visit. Entrance interview conducted. At 10:15 a.m., LPAs conducted a walk through and LPAs did not observe any immediate health and safety issues or concerns. During today's visit, LPAs requested files and conducted file review at 10:25 a.m. File review consists of but is not limited to review of physicians report, appraisal needs and services, etc. LPAs conducted interviews with the Administrator, two out of two staff, and three out of six residents from 11:00-12:00 p.m.

Allegations: Residents is not treated with dignity or respect
Staff handled residents in a rough manner
Staff yelled at residents

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa Ruiz	TELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021

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 31-AS-20211221112018

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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: A HEAVENLY HAVEN, INC. II	FACILITY NUMBER: 197606737
	VISIT DATE: 12/22/2021

NARRATIVE

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Interviews conducted with three out of six residents, who were able to communicate, stated that staff treat residents with dignity or respect. Additionally, they have never witnessed staff yell at residents. R1 stated staff speak loudly only when they speak to R6 due to R6 having a hard time hearing. Three out of six residents indicated that staff has never handled them in a rough manner. In fact, R1 stated that all staff are wonderful and very caring. R6 stated that all staff provide good service to them. Two out of two staff and the Administrator stated they always treat residents with respect, they handle residents in a gentle manner and only when they need help or ask for assistance. Lastly the Administrator stated staff never yell, they only speak louder when talking to R6.

Allegation: Resident is forced to fulfill duties of staff in the facility.

At 11:20 a.m., LPA interviewed R1 regarding the allegation mentioned above. R1 stated they have never provided care to the other residents in the facility. R1 stated they sometimes vocalize that they may need water or assistance. Additionally, R1 stated that they have voluntarily asked to help water the plants and cook because they love to cook but that when staff notice R1 getting tired, staff redirect her to get rest. The interview with the Administrator revealed R1 advocates to help with some tasks such as cooking and watering plants because R1 enjoys those hobbies.

Allegation: Facility is not kept clean.

During today's visit and upon further inspection, LPAs observed the facility to be clean and in good repair. LPAs observed the Administrator cleaning the kitchen area after meal prepping. Additionally, R1 stated that the facility is always nice and clean.

Allegation: Staff did not safeguard resident's personal items .

An interview with R1 revealed that back in October 2021, $100.00 and a debit card went missing. In result, the Administrator drove them to the bank where it was revealed that the debit card was delivered to the wrong address. R1 stated that the $100.00 were still missing.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa Ruiz	TELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20211221112018

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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: A HEAVENLY HAVEN, INC. II	FACILITY NUMBER: 197606737
	VISIT DATE: 12/22/2021

NARRATIVE

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During the interview with the Administrator it was revealed that when R1 has cash, it is being spent on cigarettes. The Administrator drives R1 to make the purchases, however no receipts are kept. LPAs advised the Administrator to keep a log of cash purchases done by all residents. Interviews with two other residents (R2 and R6) revealed that they have had no issues with personal belongings being lost or stolen.

Allegation: Staff ignores resident call for assistance.

Interviews conducted with three out of six residents indicate that staff assist residents promptly when a request for assistance is made. Interviews with the two staff members and the Administrator indicate that assistance to residents is done in a timely manner, regardless of the time. Lastly, he Administrator stated that residents are checked on periodically throughout the day and night.

Although allegations may have occurred or are valid, there is not a preponderance of evidence to prove that alleged violations did or did not occur, therefore the above seven allegations are UNSUBSTANTIATED at this time.

No deficiencies issued. Exit interview conducted and a copy of this report was delivered to the Administrator.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa Ruiz	TELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021

LIC9099 (FAS) - (06/04)

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