336425532-1-18-2023-18-AS-JESL-CT2THX-20230622144528

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336425532
Report Date: 01/18/2023
Date Signed: 01/18/2023 11:12:55 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/22/2022 and conducted by Evaluator Janira Arreola

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20221122092817

FACILITY NAME:	SERENITY HAVEN		FACILITY NUMBER:	336425532
ADMINISTRATOR:	BRANDON T. HARMISON		FACILITY TYPE:	740
ADDRESS:	24300 CANYON LAKE DR. N		TELEPHONE:	(951) 246-9465
CITY:	CANYON LAKE	STATE: CA	ZIP CODE:	92587
CAPACITY:	6	CENSUS: 3	DATE:	01/18/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Staff, Mary Anne Harmison		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff are using illegal drugs at the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Janira Arreola and Regional Manager (RM) Reyna Lacey conducted an unannounced visit to the facility in order to deliver findings on a complaint investigation. LPA met with staff Mary Anne Harmison, who was informed of the purpose of the visit.

A complaint was received for an allegation of staff doing illegal drugs at the facility. The Department conducted an investigation in which interviews were conducted, facility records were reviewed, and a tour of the facility was conducted. Interviews with staff and residents, as well as observations corroborated the Licensee’s drug use in the facility. Four (4) interviews revealed the licensee uses illegal drugs inside the facility. On December 14, 2022, Department staff visited the facility and observed and photographed what appeared to be drug paraphernalia according to their training and experience. The Licensee denies the use of drugs but admitted “I do use marijuana and I drink sometimes…”

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira Arreola	TELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

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 18-AS-20221122092817

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SERENITY HAVEN	FACILITY NUMBER: 336425532
	VISIT DATE: 01/18/2023

NARRATIVE

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However interviews of staff and residents confirmed drug use based on the following statements: observations of alcoholic beverages “all over the kitchen”, smoke can be smelled through the vents, the smoke makes staff eyes and lungs burn and it does not smell like marijuana, observation of licensee smoking “fentanyl” in a “heroin pipe” while in the living room, licensee admitted to using “crystal meth and heroine”, drug needles were observed, observations of the Licensee under the influence based on “sweating, twitching and had bug eyes and talks stupid”, Licensee admitted an adult female residing at the location is his “drug supplier” and observations of “crack pipes”, statement that odor of smoke and drugs was very strong and “made my head sick and my chest tight and I started to vomit”. The drug use has been observed as recent as December 2022.

Based on interviews and observations, the Department has sufficient evidence to support the allegation that the Licensee has used illegal drugs in the facility with residents in care. This poses an immediate risk to the residents in care. A deficiency has been cited on the LIC9099D page.

Licensee refused to participate in the exit interview process and refused to sign the report. An exit interview was conducted where this report and appeal rights were reviewed and provided to the staff, Mary Anne Harmison.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira Arreola	TELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20221122092817

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SERENITY HAVEN	FACILITY NUMBER: 336425532
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/18/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/19/2023 Section Cited CCR 87405(d)(5)	1 2 3 4 5 6 7	87405(d)(5) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (5) Good character and a continuing reputation of personal integrity." This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee stated his plan to correct was to no longer do illegal drugs. He stated he would provide a written statement stating he would no longer allow illegal drug use at the facility and will submit a drug test as proof within 1 week. The statement is due by 01/19/23. The drug test must be completed at a doctor's office to confirm it was completed by Licensee Harmon
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Based on interviews and observations, the licensee has used illegal drugs while at the facility. This poses an immediate risk to the health and safety of the residents in care.	8 9 10 11 12 13 14	and submitted to the Regional Office by 01/25/23.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira Arreola	TELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

LIC9099 (FAS) - (06/04)

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