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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604579
Report Date: 03/19/2024
Date Signed: 03/19/2024 02:09:05 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
03/13/2024 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20240313103016
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:
03/19/2024
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Sally Saif, AdministratorTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff exhibited inappropriate behavior in a clients room
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 and obtained and reviewed pertinent records. It was alleged that staff exhibited inappropriate behavior in a clients room. Interviews revealed on 03/12/2024 Staff 1 (S1) was caught exhibiting inappropriate behavior in Client 1 (C1)s room. Interviews revealed that the facility administrator was looking for (S1) and walked into C1s room to see the staffs inappropriate behavior in the presence of C1. Interviews revealed that S1 was far away from the client and no body parts were exposed or showing. Interviews revealed the administrator asked S1 to leave the facility and S1 was terminated. Interviews revealed that the administrator reported the incident correctly and promptly with an incident report and followed with a SOC 341.
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: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024
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-20240313103016
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: 03/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
03/28/2024
Section Cited
CCR
80072(a)(1)
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80072 Personal Rights
(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:(1) To be accorded dignity in his/her personal relationships with staff and other persons.
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Licensee terminated S1 as of 03/12/2024. Licensee will provide training by an outside source on Supervision and Safeguarding clients.POC due by 03/28/2024 to CCL. Licensee will submit sign in sheet and training materials by 03/28/2024.
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Based on interviews, the licensee did not ensure that 1 of 5 clients(C1) was accorded dignity in their personal relationship with staff. This posed a potential personal rights risk to persons 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: 03/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024
LIC9099 (FAS) - (06/04)
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