197610513-7-1-2025-31-AS-NMAN-DKHQM4-20250813121656

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610513
Report Date: 07/01/2025
Date Signed: 07/01/2025 04:45:39 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
06/02/2025 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20250602115622

FACILITY NAME:	FAIRHAVEN HOME 3		FACILITY NUMBER:	197610513
ADMINISTRATOR:	MORTEL, GRACELA		FACILITY TYPE:	735
ADDRESS:	22743 HAMLIN STREET		TELEPHONE:	(818) 274-1809
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY:	6	CENSUS: 6	DATE:	07/01/2025
		UNANNOUNCED	TIME BEGAN:	04:10 PM
MET WITH:	Marilyn Samson		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff did not ensure the facility had running water for the clients
Staff did not ensure the facility had electricity for the residents
Staff are not ensuring the facility is free from financial distress

INVESTIGATION FINDINGS:

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At 4:10 p.m. on 07/01/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with Staff #3 (S3) and disclosed the reason for the visit.

To investigate the allegations above, LPA conducted an initial visit on 06/04/25 and interviewed staff and clients between 1:30 p.m. and 4:00 p.m. and toured the facility inside and out at approximately 2:45 p.m.
Today, LPA conducted a record review of pertinent files at 4:15 p.m., including but not limited to staff and client rosters and documentation from the utility company and toured the facility at 4:20 p.m.

Regarding the allegations "Staff did not ensure the facility had running water for the clients", "Staff did not ensure the facility had electricity for the residents", and "Staff are not ensuring the facility is free from financial distress” it was alleged that the facility’s water and electricity were shut off from 05/31/25 – 06/01/25. It was believed that the reason for the shut-off was due to the facility’s inability to pay its bills.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2025

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 31-AS-20250602115622

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: FAIRHAVEN HOME 3	FACILITY NUMBER: 197610513
	VISIT DATE: 07/01/2025

NARRATIVE

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Interview with the licensee at 3:30 p.m. on 06/04/25 revealed the utility company turned off the facility’s power around 4:00 p.m. on Friday, 05/30/25 due to a scam. Telephonic interview with a utility company representative at 11:30 a.m. on 06/05/25 revealed the utility shut-off was the result of a mistake made by the utility company. The previous tenant had an outstanding debt of $19 which carried over onto the current tenant, the licensee. The licensee had no prior history of outstanding debts owed to the utility company. The representative noted that the utility company apologized for the mistake and turned the electricity back on 06/03/25. The licensee confirmed that power returned on 06/03/25. In the meantime, the licensee accommodated all six (06) clients by transporting five (05) to a facility in Camarillo. The remaining one (01) client visited with family until the electricity turned on. The licensee was issued a deficiency on 06/04/25 for not bringing clients to the designated shelter-in-place location listed on the facility’s emergency disaster plan. No clients staff, or the licensee noted any issues with the facility’s financial wellbeing. Interview with Staff #1 (S1) at 3:15 p.m. on 06/04/25 confirmed that they and Staff #2 (S2) used two (02) vehicles to take five (05) clients to the Camarillo house while the power was out. Staff brought all necessary medications, files, clothing and supplies to care for clients at the new location. Interview with S3 at 4:30 p.m. today confirmed that all clients were okay during the utility outage and all aspects of care were provided. Interviews with five (05) out of six (06) clients revealed they were accommodated appropriately during the power outage. Based on interviews and record review, although the facility’s power and water went out, there were no concerns for the facility’s or finances. Additionally, staff accommodated the clients’ needs and properly provided care by transporting five (05) clients to a new location with running water and electricity while one (01) client visited with family who had running water and electricity. Therefore, the allegations are deemed UNSUBSTANTIATED at this time.

No immediate health or safety concerns were observed during today’s visit.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2025

LIC9099 (FAS) - (06/04)

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