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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603496
Report Date: 03/07/2024
Date Signed: 03/07/2024 04:19:25 PM

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
02/27/2024 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240227111627
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:
03/07/2024
UNANNOUNCEDTIME BEGAN:
11:26 AM
MET WITH:Brittany Jones, AdministratorTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Clients are denied getting personal mail.
Staff did not ensure client's clothes are washed.
Staff did not assist clients in maintaining council meetings.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation for the allegations listed above. LPA arrived unannounced and met with Administrator, Brittany Jones. The purpose for the visit was explained.

LPA obtained a copy of the staff roster, client roster, and reviewed 3 client files. Interviews were held with the administrators, staff, 2 clients (C1 – C2), and the San Gabriel/Pomona Regional Center Quality Assurance Specialist. Client #3 was not home at time of visit.

The investigations revealed the following:
Allegation – Clients are denied getting personal mail. Per the administrators and staff, clients are given their mails when they are sent to them. They stated the clients have access to the mailbox that is located on the sidewalk and the mailbox is not locked. Staff stated they usually place any mail or packages that come in for C1 and C2 in front of their room door.
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: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
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-20240227111627
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: 03/07/2024
NARRATIVE
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If they are not home, they will leave it by the counter and hand it to them when they return. Both clients interviewed stated the mailbox is not locked but have access to it, although the administrator does not like them getting the mail. They also stated they feel the staff are withholding their mail until they have more to give them.

Allegation – Staff did not ensure client’s clothes are washed. Per administrators and staff, clients’ clothes are being washed several times a week and more upon request. For C1 and C2, they encourage clients to put out their basket on their assigned days to be washed. Staff stated they had accommodated with other requests made by the clients as well. They also indicated that C1 and C2 had pointed out that the staff had used too much detergent and did not like the smell of the clothes. For this reason, clients did not feel it was properly washed. LPA interviewed 2 clients who indicated that staff do not wash their clothes properly and are left smelling like mildew. There is insufficient evidence to prove this allegation.

Allegation – Staff did not assist clients in maintaining council meetings. Per administrators, one of the staff meets with the clients weekly to go over food options and any concerns. The clients will tell the staff what food they want them to make for the week in order to prepare the grocery list. Staff stated that clients can discuss any concerns with them anytime. The facility documents resident house meetings held in 2023 and as part of the regional center’s recommendation, they will continue to hold and document resident council meetings. Both clients interviewed stated the facility do not hold council meetings. When they attempt to schedule a meeting, they stated it felt more like a threat to find them another placement.

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 Jones. 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: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2