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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604579
Report Date: 12/18/2024
Date Signed: 12/18/2024 03:45:12 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
05/21/2024 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20240521145139
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:
12/18/2024
UNANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Sally Saif, AdministratorTIME COMPLETED:
12:35 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff is not meeting residents medical needs
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to close out the complaint investigation. 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 staff is not meeting residents medical needs. Interviews revealed that Staff 1 (S1) takes Client 1 (C1) to their medical, dental, orthopedic and Psychiatric appointments. C1s psychiatric appointments are online with Zoom. S1 admits that there have been some appointments that were rescheduled but not missed due to her carelessness, S1 admits that the appointments are scheduled usually right after another appointment and the time between appointments there are several things that can occur as to why they would need to reschedule the appointment. Interviews with staff admit that they are taking care of six clients in total and have several different appointments for each client that they all must attend. Interviews revealed that if there is an appointment that needs to be rescheduled that they call and reschedule and does their best to reschedule it close to the original appointment date.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
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 3
Control Number 08-AS-20240521145139
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: 12/18/2024
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
Interviews revealed that the log for appointments showed C1 had appointments on these days for medical, psychiatric, dental, podiatry and cardiology.
August 2023
2 Psych
3 Podiatry
15 Cardiology

September 2023
No Appointments

October 2023
11 Podiatry
16 Dentist appointment canceled and rescheduled for 10/31
18 Psych
31 Dental

November 2023
15 Psych
27 Physical rescheduled to 12/5

December 2023
5 Physical
18 Tele health

January 2024
3 Psych

February 2024
1 Dental

March 2024
20 Psych

{Continued]
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20240521145139
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: 12/18/2024
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
April 2024
4 Referral to Family Health Center (FHC)
30 Endoscopy with FHC

May 2024
8 Psych - Family made appointment S1 did not due to conflict of schedule
22 Follow up Psych from the 8th

June 2024
13 Dental
20 Podiatry

July 2024
17 Psych

August 2024
No Appointments

Dental appointments confirmed by Front Desk Clerk at Delta Aid:
August 2022, April 2023, October 2023, November 2023, February 2024, June 2024, September 2024 and December 2024 which was canceled on 12/18/2024 due to CCL arriving unannounced at the facility. There was one appointment cancelled in May 2024 that was rescheduled for June 2024. Total of two (2) cancellations for 2024.

Interviews with an outside source revealed that S1 is meeting C1s needs by taking them to their appointments and rescheduling when needed. Interviews with outside source revealed no other issues with any other clients regarding missed appointments. Interviews with S1 revealed the appointments that were canceled were all rescheduled and were canceled for numerous reasons for instance clients behaviors, conflict of scheduling and or refusal from the client.
The above-mentioned allegation of staff is not meeting residents medical needs is 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: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3