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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603322
Report Date: 11/14/2024
Date Signed: 11/14/2024 10:17:29 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/21/2024 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240621092641
FACILITY NAME:HAVEN HOUSE RESIDENTIAL FACILITIES INCFACILITY NUMBER:
198603322
ADMINISTRATOR:CAGE, WANDAFACILITY TYPE:
735
ADDRESS:757 EDWIN AVETELEPHONE:
(909) 436-7423
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY:4CENSUS: 2DATE:
11/14/2024
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:John AlfredTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Personal Rights/ Client was possibly sexually abused.
Personal Rights/Due to a lack of supervision clients engaged in inappropriate interactions.
Personal Rights/Due to a lack of supervision clients engaged in physical altercation.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Irra conducted a subsequent visit to deliver findings for the above allegations. LPA met John Alfred and explained the purpose of today’s visit.

On 06/21/24, LPA Irra conducted a tour of the building and grounds and did not observe any signs of neglect, abuse or other immediate health and safety threats. During this visit, LPA reviewed Client #1 (C-1) and Client #2 (C-2) files and obtained relevant documentation. Additionally, LPA obtained a copy of the staff schedule and a copy of the client roster.

During this investigation, Investigator Laura Garcia (CCLD-Investigation Branch) interviewed C-1’s physician, C-1’s San Gabriel Regional Center Service Coordinators, C-1’s family member/authorized representative and facility staff (Staff #1 through Staff #3). Per Investigator Garcia’s report, C-1 was not interviewed due to C-1’s mental disabilities and other clients were not interviewed as they are non-verbal. **Refer to LIC 9099C for the continuation of this report.**
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
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 28-AS-20240621092641
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: HAVEN HOUSE RESIDENTIAL FACILITIES INC
FACILITY NUMBER: 198603322
VISIT DATE: 11/14/2024
NARRATIVE
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Allegation: Personal Rights/ Client was possibly sexually abused. It was alleged that during C-1’s medical appointment (06/19/2024), C-1’s allegedly had signs of anal penetration. Per Investigator Laura Garcia’s report, “according to statements, there were no witnesses to any type of sexual penetration between clients”. C-1 moved out from this facility on 04/25/24. During this investigation, per Investigator Garcia’s report, C-1’s physician indicated that there was insufficient evidence to indicate that C-1 was sexually abused. Per Investigator Garcia’s report, “based on statements provided, there is not enough evidence to determine if C-1 was sexually abused due to neglect/lack of care” by this facility. Interviewed staff denied possible sexual abuse. Clients were not interviewed due to their cognitive disabilities and/or being non-verbal. Interviews do not corroborate this allegation.

Allegation: Personal Rights/Due to a lack of supervision clients engaged in inappropriate interactions. It was alleged that when C-1 and C-2 shared a room, both were caught doing inappropriate acts. Per Investigator Garcia, an incident was reported on 09/22/23, in which both C-1 and C-2 were inappropriately touching each other. Per investigation, immediate action was taken by facility staff and preventative measures were implemented in order to prevent further incidents. Staff immediately intervened, separated C-1 and C-2, moved both C-1 and C-2 to separate bedrooms and held a meeting. There were no further incidents of this nature since the preventative measures were implemented. A Special Incident Report (SIR) pertaining to this incident was sent to San Gabriel Pomona Regional Center and Community Care Licensing. Interviews and documentation do not corroborate this allegation.

Allegation: Due to a lack of supervision clients engaged in physical altercation. There was not detailed information provided for this allegation. During this investigation, it was determined that on 04/23/24, C-1 and C-2 had a physical altercation. During the altercation, per staff interviews, facility staff intervened and stopped the altercation. There is no evidence to support that due to lack of supervision clients engaged in a physical altercation. A Special Incident Report (SIR) pertaining to this incident was sent to San Gabriel Pomona Regional Center and Community Care Licensing. Interviews and documentation do not corroborate this allegation.

Based on record review and interviews conducted the findings indicate, although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.



An exit interview conducted, appeal rights and a copy of this report was provided to John Alfred.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC9099 (FAS) - (06/04)
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