486803978-7-24-2026-21-AS-KMOA-DWGR98-20260730124907

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803978
Report Date: 07/15/2026
Date Signed: 07/24/2026 12:31:19 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/13/2026 and conducted by Evaluator Ethel Contreras

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20260513131336

FACILITY NAME:	HOLY HAVEN 1		FACILITY NUMBER:	486803978
ADMINISTRATOR:	PASCUA, LESLIE ANN		FACILITY TYPE:	735
ADDRESS:	137 SUMMERTIME LANE		TELEPHONE:	(707) 673-4142
CITY:	SUISUN CITY	STATE: CA	ZIP CODE:	94585
CAPACITY:	5	CENSUS: 3	DATE:	07/15/2026
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Leslie Ann Pascua-Administrator		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff did not provide adequate supervision resulting in resident sexually touching another resident.
Staff did not seek medical attention to resident in a timely manner.
Staff speaks to resident in an inappropriate manner.
Staff does not provide adequate food service.
Staff does not ensure residents have adequate toiletry supply.

INVESTIGATION FINDINGS:

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Licensing Program Analyst Contreras arrived unannounced to deliver findings for the above allegations. During the course of the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. LPA was greeted by staff Melanie Concepcion. Administrator Leslie Ann Pascua arrived afterwards.

Allegation regarding staff did not provide adequate supervision resulting in resident sexually touching another resident. C1 reported C2 touched C1 inappropriately. Based on interviews with clients and staff, C2 does not have a history of inappropriate behavior. Staff interviews reported C1 has history of walking naked in communal areas, making comments about getting clients evicted and falsely accusing others of misconduct. C1 and C2 do not require one-to-one supervision and clients were permitted to enter each other’s room prior to the incident. There is insufficient evidence to conclude that inappropriate acts occurred between C1 and C2 including that staff failed to provide required supervision.

continued onto 9099-C.....

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Ethel Contreras
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026

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 4

Control Number 21-AS-20260513131336

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: HOLY HAVEN 1	FACILITY NUMBER: 486803978
	VISIT DATE: 07/15/2026

NARRATIVE

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continued from 9099......
So, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Allegation regarding staff did not seek medical attention to resident in a timely manner. Based on interviews and file review, facility took client to seek medical attention when it was expressed that it was needed. When administrator took C1 to urgent care, C1 expressed wanting to go home because C1 did not want to wait for care. Stated by admin, about five out of the eight times that C1 would request to be taken to urgent care, once at urgent care, C1 would express wanting to go back home and refused to be seen by doctor due to wait time at hospital. Staff appeared to have taken action for each time client expressed needing to seek medical attention and would take client to urgent care when necessary. There is no indication that client would not be taken to seek medical attention in timely manner. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Allegation regarding staff speaks to resident in an inappropriate manner. Reporting Party (RP) alleges staff speaks to resident in an inappropriate manner. Based on Department interviews, Client (C1) stated there is always a staff member present who assists them in meals, general cleaning, laundry services and medication administration. Based on LPA interview, C1 reported feeling safe at facility. Department Interviews with Client (C2) stated, “felt safe and has always received help from staff.” Additionally, no residents at facility shared any concerns of staff speaking to them in an inappropriate manner. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Allegation regarding staff does not provide adequate food service. LPA observed a 2-day perishable and a 7-day non-perishable amount of food including emergency food and water supply to meet Title 22 Regulations. Based on client interviews, it was stated that facility provides three meals a day including homemade dinners given with either fruit or vegetables. Upon LPA observation, snacks and canned goods were also available and accessible to clients. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

continued onto 9099-C2

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Ethel Contreras
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 21-AS-20260513131336

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: HOLY HAVEN 1	FACILITY NUMBER: 486803978
	VISIT DATE: 07/15/2026

NARRATIVE

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continued from 9099-C....

Allegation regarding staff does not ensure residents have adequate toiletry supply. RP alleges staff does not ensure residents have adequate toiletry supply. LPA observed all bathrooms accessible to clients to have required hand soap, paper towels and toilet paper. Based on LPA client interviews when asked if there is toilet paper in bathrooms, it was stated, “Admin makes sure I don’t run out of it.” In addition, LPA observed a pack of toilet paper in private restroom and substantial amount of paper towels and toilet paper in storage closets. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No deficiencies given during today's visit.

Report given and read with administrator.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Ethel Contreras
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026

LIC9099 (FAS) - (06/04)

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