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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604579
Report Date: 10/09/2024
Date Signed: 10/09/2024 03:41:17 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
02/27/2024 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20240227102628
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: 6DATE:
10/09/2024
UNANNOUNCEDTIME BEGAN:
09:48 AM
MET WITH:Sally Saif, AdministratorTIME COMPLETED:
10:55 AM
ALLEGATION(S):
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Staff injured resident while in care
Staff handled residents in a rough manner
Resident sustained unexplained bruises
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to close a complaint investigation into the above listed allegations. 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 staff injured resident while in care. Interviews revealed the client arrived home from program and was having a behavior. Interviews revealed the Staff 1 (S1) walked to the bus to get the client around 4 pm and they both walked down the facility driveway all the while the client was screaming. Interviews revealed as the staff attempted to assist the client into the facility. Interviews revealed the client was very combative and aggressive with staff. Interviews revealed C1 was pulling S1 clothes, hitting and kicking. Interviews revealed C1 bit a plug out of S1's arm. S2 came outside and was able to intervene while getting their hair pulled and pinched and hit.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024
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-20240227102628
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: 10/09/2024
NARRATIVE
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 S1 went into the house and S2 was outside with C1. Interviews revealed that S3 was handling the medications and cooking while supervising the other clients. Interviews revealed that C1 ran to the work van, started banging their head on the van and fighting S2. C1 took off one shoe and was hitting S2 with it and S2 tried to stop C1. Interviews revealed that S2 was able to call 911 for the PERT team. Interviews revealed as they were waiting for PERT C1 continued to pull S2's hair, and hit S2. Interviews with staff revealed that C1 grabs hair, clothes and anything they can pretty much grab a hold too and will throw punches at the same time. Interviews revealed the PERT team arrived about 430/500 pm. Interviews revealed they took C1 to the hospital as C1 was a danger to self and others.

It was alleged that the staff handled residents in a rough manner. Interviews revealed the staff did not handle the clients roughly. Interviews with staff denied the allegation and stated that they are always thinking of the safety for the clients. Interviews revealed if a client is having a behavior they are right there supervising them and trying to redirect them. Interviews revealed that if a client grabs a hold of them and is aggressive with them they will try to get away from the client so they won't get hurt while trying to make sure the clients don't get hurt either. Interviews with an outside source stated that C1 is known for these behaviors and they are rough. Interviews revealed they do not think the staff would purposely hurt the clients and does not believe they are handling them roughly.

It was alleged that the resident sustained unexplained bruises. Interviews with outside sources revealed the staff are not physically grabbing the clients to cause bruising. Interviews revealed this particular client needs to be in a higher level of care and the behaviors C1 has is a lot for the level 4. Interviews revealed that C1 is hurting or bruising the clients and themselves. Interviews revealed that C1 was in the hospital and they used restraints on C1 due to their behaviors and that is another reason they could possibly have the bruises. Interviews revealed that when incidents happen, the staff hold on to the clients and when they are aggressive they may hold on a little tighter to keep the clients safe but not to hurt them or cause any harm.

The above-mentioned allegations are unsubstantiated. 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.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2