565801311-8-4-2023-29-AS-DPEA-CV5SF6-20230828134949

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801311
Report Date: 08/04/2023
Date Signed: 08/04/2023 04:46:56 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/03/2023 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20230803103511

FACILITY NAME:	HAAVE HOUSE		FACILITY NUMBER:	565801311
ADMINISTRATOR:	BONNIE M. HAAVE		FACILITY TYPE:	740
ADDRESS:	315 RIVERSIDE ROAD		TELEPHONE:	(805) 649-0704
CITY:	OAK VIEW	STATE: CA	ZIP CODE:	93022
CAPACITY:	6	CENSUS: 6	DATE:	08/04/2023
		UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Bonnie Haave		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Resident was hit by staff

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Esther Cortez conducted an unannounced initial complaint visit for the above allegations. Upon arrival at 12:50 p.m., LPA met with staff Maria Dye. Administrator Bonnie Haave arrived shortly after. Entrance interview conducted and the reason for the visit was explained.

It was alleged that resident was hit by staff. It was reported that staff hit Resident #1 (R1). The Reporting Party (RP) did not provide any further details regarding the incident. Per the RP, R1 does not have marks or bruises.

During today’s visit, LPA Cortez along with staff Maria Dye toured the facility at 1:00 p.m. LPA also conducted interviews with staff approximately between 1:10 p.m. and 1:17 p.m.; interviews with residents were conducted approximately between 1:30 p.m. and 2:37 p.m. The LPA reviewed and obtained pertinent documents at approximately 2:40 p.m. At 3:46 p.m., the LPA also conducted an interview with R1s family. Report will continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

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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Control Number 29-AS-20230803103511

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: HAAVE HOUSE	FACILITY NUMBER: 565801311
	VISIT DATE: 08/04/2023

NARRATIVE

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Information gathered revealed that there has not been any residents report of being hit by any staff. The Administrator stated that she has never, not once ever heard any residents or staff voice concerns about residents being hit. Additionally, administrator further stated that if she heard of any concerns, staff would immediately be reprimanded and Community Care Licensing (CCL) will be notified. Interviews conducted with residents reflected that they could communicate with staff at anytime if they feel uncomfortable. The Interview conducted with R1’s family revealed that they often visit R1 at the facility, talk to R1 every day and are happy with the care the facility provides. Additionally, R1’s family stated that they do not have any concerns with R1's safety. Interviews conducted with residents further revealed that residents are happy and feel safe in the care of the staff. Furthermore, R1 stated facility staff have never hit them while living at the facility. Based on information gathered during the course of the investigation, the Department does not have sufficient evidence to determine staff hit R1. Therefore, the above all allegation “Resident was hit by staff”, is deemed UNSUBSTANTAITED at this time.

No immediate health and safety hazards were observed during today's visit.

No deficiencies cited. Exit interview conducted. A copy of the report was issued to administrator Bonnie Haave.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

LIC9099 (FAS) - (06/04)

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