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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603496
Report Date: 02/29/2024
Date Signed: 02/29/2024 11:42:07 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
01/12/2024 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240112103511
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: 3DATE:
02/29/2024
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Tega Ugbeyide, Co-AdministratorTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Facility staff was emotionally abusive towards clients.

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent complaint investigation regarding allegation, facility staff was emotionally abusive towards clients. LPA arrived unannounced and met with Administrators, Brittney Jones and Tega Ugbeyide. The purpose of the visit was explained.

LPA Chan conducted the initial visit on 1/19/24. LPA obtained a copy of the staff roster, client roster, and collected documents for Clients #1 - #2. Interviews were held with the administrator, co-administrator, Staff #1 - #5, and Clients #1 (C-1). During the visit today, LPA interviewed Client #2 (C-2) and Client #3 (C-3) was not home to be interview.

The investigation revealed the following for allegation, facility staff was emotionally abusive towards clients. It was alleged the administrator made comments that caused the clients to feel insecure. LPA reviewed documentations and conducted interviews to determine findings.
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: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024
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 2
Control Number 28-AS-20240112103511
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: 02/29/2024
NARRATIVE
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 LPA interviewed the administrators who denied making comments towards clients deliberately to make them feel insecure. They denied discussing or providing information regarding the clients in front of other clients. They stated they treat them with respect and try to create a family-like environment to include clients in their decision making and to provide them with safe surroundings. However, Clients #1 (C-1) and #2 (C-2) are not receptive to anything they say. LPA interviewed 5 other staff members. Staff interviewed have not heard or seen other staff threatening or abusing clients. They do not discuss matters regarding the clients in front of clients nor in areas where clients can hear. They treat clients respectfully and professionally. LPA reviewed documents for C-1 and C-2. Per documentation, C-1 and C-2’s behaviors include making false statements and is a behavior that facility is working with clients on reducing. LPA interviewed 2 out of 3 clients and clients stated staff make them feel insecure. They discuss things to others over the phone that is causing them to be fearful of the facility’s action. Based on information gathered, there is insufficient evidence to corroborate the allegation.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2