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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604719
Report Date: 12/02/2025
Date Signed: 12/02/2025 05:37:37 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
07/31/2025 and conducted by Evaluator Tiffany Holmes
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20250731150952
FACILITY NAME:CRYSTAL CARE FACILITY INCFACILITY NUMBER:
374604719
ADMINISTRATOR:SAIF, SALLYFACILITY TYPE:
735
ADDRESS:9026 MAC LANETELEPHONE:
(248) 307-6966
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:4CENSUS: 4DATE:
12/02/2025
UNANNOUNCEDTIME BEGAN:
05:18 PM
MET WITH:Sally Saif, AdministratorTIME COMPLETED:
05:34 PM
ALLEGATION(S):
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9
Staff threw pen at resident
Staff do not provide resident enough food to meet their needs
Staff would not allow resident to go to day program
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA)Tiffany Holmes contacted the facility to deliver findings for a complaint investigation via tele-virtual. LPA identified herself to, and explained the purpose of the visit and the basic elements of the complaint with Sally Saif, Administrator

LPA previously conducted interviews with residents, staff, and outside sources, and made observations. LPA conducted the initial visit on August 5, 2025 and conducted a tour of the facility. It was alleged that the staff threw pen at resident, staff do not provide resident enough food to meet their needs and staff would not allow resident to go to day program. Interviews revealed clients denied that a pen was thrown at them, along with staff interviews, they denied the allegation of staff throwing a pen at a resident. Interviews revealed that the clients receive a vegetable, starch and protein at each meal. Interviews revealed that the clients have a variety of food choices to choose from. Interviews revealed that the clients take pasta , spaghetti and sandwiches to lunch along with jello or pudding. The clients also have a variety of meals to choose from for dinner as well. There were no complaints from the outside source or the clients on the food. Interviews revealed that clients go to program and interviews revealed the staff denying the allegation of not letting the clients go to program. Interviews revealed the clients stay home from program if they are sick or not feeling well or if they have an appointment. Interviews with clients revealed the staff have not made them stay home and miss program.

The Department has investigated the above-mentioned allegations and based on interviews, and LPA observations, it was determined that the complaint allegations are unsubstantiated. The allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred

An exit interview was conducted with Adminsitrator Sally Saif via face time and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided via email. An electronic email read receipt confirms the documents were received.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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