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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604579
Report Date: 01/26/2023
Date Signed: 01/27/2023 07:57:32 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/17/2023 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20230117123633
FACILITY NAME:HEALING ADULT GROUP CARE INC.FACILITY NUMBER:
374604579
ADMINISTRATOR:SAIF, SALLYFACILITY TYPE:
735
ADDRESS:3919 EL CANTO DR.TELEPHONE:
(248) 307-6966
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:6CENSUS: 2DATE:
01/26/2023
UNANNOUNCEDTIME BEGAN:
01:13 PM
MET WITH:Licensee Sally SaifTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff made inappropriate comments towards client.
Staff is not meeting client's medical needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit regarding the above listed complaint allegations. LPA identified herself and discussed the purpose of the visit and the elements of the allegations with Licensee Saif.

During today's visit LPA Correia conducted client and staff interviews. LPA also secured and reviewed pertinent client records.

It was alleged staff made inappropriate comments towards client(s) in care. An interview conducted with Client1 (C1) (see LIC811 Confidential Names List) revealed they felt facility staff were very nice to them, and also revealed no problems regarding how they were treated by facility staff. It was also alleged staff were not meeting client(s) medical needs. An interview with C1 revealed facility staff were not checking their blood sugar levels as needed. An interview with facility Staff1 (S1) and a review of current Outside Source1 (OS1) records revealed there are no orders by C1's attending Physician for testing C1's blood sugar levels.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
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 08-AS-20230117123633
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: HEALING ADULT GROUP CARE INC.
FACILITY NUMBER: 374604579
VISIT DATE: 01/26/2023
NARRATIVE
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Based on interviews conducted with a client and staff member, and client and outside source records review, the above allegations were determined to be unsubstantiated. An unsubstantiated finding means although the allegations may have occurred the preponderance of evidence standard has not been met.

An exit interview was conducted with Licensee Saif and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) will be provided. Signature of this form confirms receipt the documents were received.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2