<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604579
Report Date: 11/22/2024
Date Signed: 11/22/2024 06:30:07 PM

Document Has Been Signed on 11/22/2024 06:30 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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
ADMINISTRATOR/
DIRECTOR:		SAIF, SALLYFACILITY TYPE:
735
ADDRESS:3919 EL CANTO DR.TELEPHONE:
(248) 307-6966
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY: 6CENSUS: 6DATE:
11/22/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Administrator, Sally SaifTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA), Marisela Garcia-Centeno, conducted a case management visit to cite a deficiency observed during a complaint investigation visit conducted on August 21, 2024. LPA was allowed entry by Staff, Nargis Hamidi. LPA met with Administrator, Sally Saif, over the telephone as she was not at the facility during the visit. Administrator, Sally Saif arrived at the facility at the end of the visit and signed the report.

On August 21, 2024, during a complaint visit, it was disclosed that staff sent a client (C1) over medicated to school instead of seeking immediate medical attention. [an LIC 811 Confidential Names List was provided to staff to identify the client].

During an investigation, it was determined that staff sent C1 to school in a comatose state on August 13th, 14th, 15th, 16th, 19th, 20th, and 21st, 2024. Although staff administered medication as ordered, staff failed to obtain immediate medical attention as required per regulation to meet C1’s medical needs. C1 displayed some of the negative side effects (dizziness and drowsiness) associated with the prescribed medication. When C1 arrived at school, C1 was evaluated by the school nurse and the appropriate school personnel called 911. C1 was transported to the nearest hospital on August 13th and 14th, 2024. According to hospital discharge notes, C1 had elevated levels of medication and C1 was in an altered state. In addition, C1 was also diagnosed with a UTI and was prescribed antibiotics. On August 15, 2024, C1 arrived at school in a comatose state again. When school staff determined that C1 was in an unstable condition to attend school. C1 was sent back to the facility by school transportation services and the school nurse followed the school bus to ensure C1 was transported safely back to the facility.

(continue at LIC809C)
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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
VISIT DATE: 11/22/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(continue from LIC809)


Per California Code of Regulations, Title 22. deficiencies were cited in an LIC 809D. A plan of correction was developed with Administrator, Sally Saif via telephone.

An exit interview was conducted with Administrator, Sally Saif over the telephone. A copy of this report, LIC 809D, LIC811 Confidential Names list, and Licensee's Rights (LIC 9058 03/22) were provided at the conclusion of the visit to Saif.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 11/22/2024 06:30 PM - It Cannot Be Edited


Created By: Marisela Garcia-Centeno On 11/22/2024 at 11:47 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 11/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
01/17/2025
Section Cited
CCR
80075(a)

1
2
3
4
5
6
7
8007 Health Related Services
(a) The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services, including arrangement for and/or provision of transportation to the nearest available services. License did not obtain medical attention as required to meet C1 medical needs. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
LIcensee agreed to conduct in service training by an outside provider to ensure staff provide immediate medical attention to meet clients needs. Licensee agreed to submit documentation for inservice training by POC date of 12/23/2024.
8
9
10
11
12
13
14
Based on observations, interviews with staff, and outside sources, the licensee did not ensure staff provided immediate medical attention as required to meet C1’s medical needs and C1 was sent to school when it was not safe to do so. This posed a potential health risk to one (1) of six (6) clients in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Jennifer Lott
LICENSING EVALUATOR NAME:Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2024


LIC809 (FAS) - (06/04)
Page: 3 of 3