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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604579
Report Date: 02/08/2024
Date Signed: 02/08/2024 02:35:31 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
01/31/2024 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20240131173233
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: 5DATE:
02/08/2024
UNANNOUNCEDTIME BEGAN:
01:02 PM
MET WITH:Sally Saif, AdministratorTIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Licensee had a locked dead bolt on facility exit door
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to open a complaint investigation into the above listed allegation. LPA introduced herself, was granted entry, and met with Sally Saif, Administrator, to whom she disclosed the reason for the visit.
LPA conducted interviews, made observations, and obtained and reviewed pertinent records. It was alleged that the licensee had a locked dead bolt on the facility exit door. Interviews revealed there were 3 (911) calls within a week due to the facility having a locked dead bolt on an exit door of the facility. Interviews from outside sources revealed that the staff on duty did not have a key present for the exit door to exit the house from inside to outside. Interviews revealed the fire department came out to the facility on January 31, 2024 to take a client to the hospital and while at the facility they observed the lock on the front door and immediately brought it to the attention of the staff that it needed to be removed due to it being a fire hazard. Interviews revealed that they removed the lock the same day and put a lock that turns so the clients are able to get out in case of an emergency.
Interviews also revealed that the keys would not be in the door (in the lock) at times. The staff would be able to unlock the doors but the kets were seperate. Interviews revealed the lock has been changed and that it is safer for the everyone that the deadbolt like is not in the door any longer. The above-mentioned allegation is substantiated. The violation is cited in accordance with California Code of Regulations, Title 22, and is recorded on the attached 9099-D (Deficiency) Page.
An exit interview was conducted with Sally Saif, Administrator and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2024
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 08-AS-20240131173233
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: HEALING ADULT GROUP CARE INC.
FACILITY NUMBER: 374604579
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/23/2024
Section Cited
CCR
80072(a)(7)
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Personal Rights: Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: Not to be locked in any room, building, or facility premises by day or night.
This requirement is not met as evidenced by:
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Licensee immediately removed the lock from the door once the fire department told them. The licensee will have personal rights training for all staff and will submit training materials and sign in sheet for the training by Plan of Corrections due date of 02/23/2024
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Based on review of records and interviews, the licensee did not ensure 5 of 5 clients in care werent locked in the facility with a deadbolt. On 02/08/2024 LPA observed, the deadbolt lock to have been removed from the facility door. This posed an immediate health and safety risk to clients in care.
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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.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2