<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603496
Report Date: 05/03/2024
Date Signed: 05/03/2024 10:47:00 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
02/05/2024 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240205134334
FACILITY NAME:SAFE HAVEN ADULT RESIDENTIALFACILITY NUMBER:
198603496
ADMINISTRATOR:JONES, BRITTANYFACILITY TYPE:
735
ADDRESS:980 LOOKING GLASS DRTELEPHONE:
(310) 977-6212
CITY:DIAMOND BARSTATE: CAZIP CODE:
91765
CAPACITY:4CENSUS: 1DATE:
05/03/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Brittany Jones, AdministratorTIME COMPLETED:
10:55 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not providing adequate food service to clients.
Staff do not treat client with respect.
Staff is planting dangerous items in residents' rooms.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit to deliver findings for the allegations listed above. LPA met with Administrator, Brittany Jones, and explain the purpose of the visit.

On 2/13/24, LPA Chan conducted the initial visit and obtained copies of the staff roster, client roster, menu, and documents pertaining to Clients #1 and #2 (C1 and C2). LPA also interviewed the administrator. Interviews with the co-administrator, 4 staff members, and 2 clients were held on different dates.

The investigation revealed the following:
Staff are not providing adequate food service to clients. It is alleged that staff serve microwaved meals, minimal amounts of food, and a lack of food choices. LPA interviewed the administrators and 4 staff regarding the food provided.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
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 5
Control Number 28-AS-20240205134334
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: SAFE HAVEN ADULT RESIDENTIAL
FACILITY NUMBER: 198603496
VISIT DATE: 05/03/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
All the staff stated they provided adequate food to the clients. They said staff cook different dishes daily and do not use microwavable meals to substitute for a healthy cooked meal. Staff indicated that clients may have seconds if they wish. Staff asks the clients weekly what they would like to eat, and the staff would go purchase the ingredients needed for the week. LPA observed weekly menus with clients’ food of choice and observed a variety of food options in the refrigerator and freezer. During 2 of the visits made, LPA observed home-cooked breakfasts with juice. Clients #1 and #2 came out to eat their meal and returned to their rooms. Client #3 had already left for school during the visits. Although 2 of the clients mentioned there is inadequate amount of food and choices, there is insufficient evidence to corroborate this allegation.

Staff do not treat clients with respect. It is alleged that staff yell, stare down at them, and use tone of voice that is disrespectful. Staff denied treating clients disrespectfully. They stated that they are trained to treat clients fairly and respectfully. All the staff stated that when staff ask them to do something, C1 and C2 would not comply and/or get verbally aggressive with the staff. When they tried to explain things to C1 and C2, they would not listen and slam the door to their rooms. Staff stated the clients would talk harshly and try to provoke staff to respond. Staff indicated they have been patient with the clients and understand the behaviors they could engage in. Staff denied ever yelling at the clients. They are careful in their tone of voice so they would not trigger any aggression from clients.

Staff is planting dangerous items in clients’ rooms. It is alleged that clients found medications and a gutter knife in their rooms. Per the administrators, the police officer conducted a health and safety check due to a knife found in one of the client’s rooms. When the police showed up, the client stated there were no knives or weapons in their room, although they told staff that they found the knife in the room. As for medications found in the room, staff said that C1 found medications in C2’s which did not belong to the client. It was later verified that the client’s mother had given the client the medications. Staff stated they do not go into clients’ rooms when they are not home and would not plant any dangerous items in their rooms.

Although the allegations 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 was conducted with Administrator. A copy of this report along with the appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
02/05/2024 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240205134334

FACILITY NAME:SAFE HAVEN ADULT RESIDENTIALFACILITY NUMBER:
198603496
ADMINISTRATOR:JONES, BRITTANYFACILITY TYPE:
735
ADDRESS:980 LOOKING GLASS DRTELEPHONE:
(310) 977-6212
CITY:DIAMOND BARSTATE: CAZIP CODE:
91765
CAPACITY:4CENSUS: 1DATE:
05/03/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Brittany Jones, AdministratorTIME COMPLETED:
10:55 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff issued an illegal eviction to client.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit to deliver findings for the allegation listed above. LPA met with Administrator, Brittany Jones, and explain the purpose of the visit.

On 2/13/24, LPA Chan conducted the initial visit and obtained copies of the staff roster, client roster, menu, and documents pertaining to Clients #1 and #2 (C1 and C2). LPA also interviewed the administrator. Interviews with the co-administrator, 4 staff members, and 2 clients were held on different dates.

Allegation - Staff issued an illegal eviction to client. It is alleged that clients #1 (C1) and #2 (C2) were served eviction notices for no major issues and because staff do not want them to live there. LPA interviewed the administrators who stated the 30-day eviction notice was given to both C1 and C2 due to non-compliance with house rules.

Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20240205134334
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: SAFE HAVEN ADULT RESIDENTIAL
FACILITY NUMBER: 198603496
VISIT DATE: 05/03/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Administrators stated the 2 clients are continuously ignoring staffs’ requests. They do not comply with cleaning their rooms or allow staff to clean their rooms. LPA interviewed 4 staff who also indicated that C1 and C2 do not comply with many of their requests and tend to shout or become aggressive with staff. LPA reviewed the eviction notice given to C1 and C2. Although the administrator informed LPA of the reasons for the eviction, the specific facts with the dates were not included in the notice that were given to the clients on 1/8/24. Therefore, the eviction notice was missing certain elements to make this valid.

Based on interviews conducted and record review, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 and Chapter 6), are being cited on the attached LIC 9099D.



An exit interview was conducted. A copy of this report and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20240205134334
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: SAFE HAVEN ADULT RESIDENTIAL
FACILITY NUMBER: 198603496
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/03/2024
Section Cited
CCR
85068.5(c)
1
2
3
4
5
6
7
85068.5 Eviction Procedures
(c) The licensee shall set forth in the notice to quit the reasons for the eviction, with specific facts including the date, place, witnesses, and circumstances.
1
2
3
4
5
6
7
The licensee shall review the eviction procedures and re-issue the eviction notice to Clients #1 and #2.

***Clients #1 and #2 have moved out of the facility.*** POC has been cleared.
8
9
10
11
12
13
14
Based on record review, the administrator did not ensure the eviction notice included the specific facts or reasons for eviction which poses a potential personal rights risk to clients in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5