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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604579
Report Date: 07/25/2024
Date Signed: 07/25/2024 03:42:16 PM

Unsubstantiated


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
06/27/2024 and conducted by Evaluator Marisela Garcia-Centeno
COMPLAINT CONTROL NUMBER: 08-AS-20240627125228
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:
07/25/2024
UNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Administrator, Sally Saif TIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff left resident on the floor without a diaper
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced complaint visit to deliver investigative findings. LPA was granted entry into the facility and identified herself to Administrator, Sally Saif, to whom LPA explained the reason for the visit.

On June 27, 2024, Community Care Licensing (CCL) received a complaint alleging that
a resident (R1), [LIC811 Confidential Name List was provided to staff to identify R1], was left on the floor without a diaper. On March 12, 2024, there was an incident involving a staff member engaging in inappropriate behavior in the presence of R1. It was specifically alleged that during this incident, R1 was observed in their room on the floor without a diaper. The incident regarding the staff member’s inappropriate behavior was fully investigated by CCL and the investigation was finalized on March 19, 2024. The prior investigation did not yield corroborating evidence that R1 was left on the floor without a diaper.

(Continue at LIC812C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
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-20240627125228
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
VISIT DATE: 07/25/2024
NARRATIVE
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(Continue from LIC812)

In addition, during multiple interviews with staff and outside sources conducted as part of this investigation, it was consistently indicated that R1 was observed sitting on the floor with a diaper on trying to put on their pants. Staff assisted R1 with their dressing needs as required per R1’s service care plan.

The Department has investigated the above-mentioned allegation and based on interviews with staff and outside sources, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated.

An exit interview was conducted with Administrator, Sally Saif, to whom a copy of this report, LIC811 Confidential Name List, and the Licensee Appeal Rights (LIC9058 03/23), were provided at the conclusion of the visit.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2