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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197606737
Report Date: 12/12/2022
Date Signed: 12/12/2022 01:51:52 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/03/2022 and conducted by Evaluator Joscelyn Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20221103152702
FACILITY NAME:A HEAVENLY HAVEN, INC. IIFACILITY NUMBER:
197606737
ADMINISTRATOR:FRANCISCA RECEDEFACILITY TYPE:
740
ADDRESS:20000 LASSEN STREETTELEPHONE:
(818) 775-9397
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY:6CENSUS: 5DATE:
12/12/2022
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Francisca Recede TIME COMPLETED:
02:00 PM
ALLEGATION(S):
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9
Staff records are not accurate.
INVESTIGATION FINDINGS:
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On 12/12/22 Licensing Program Analyst (LPA) Joscelyn Martinez arrived at the facility to conduct an unannounced subsequent complaint investigation. Upon arrival LPA met with administrator and the purpose of the visit was explained.

Allegation: Staff records are not accurate.
It is alleged that the facility is still using former staff records. To investigate this allegation LPA conducted interview with Administrator Fransicsca on 11/08/22. Interview revealed that facility does not use records from former staff. Records are archived at the facility which according to regulations files need to be retained for three years after termination. LPA observed former staff files in a cabinet that were archived, and current staff files where located in a separate location in the office area. LPA collected staff file and a current Personnel Report (LIC 500) Based on interview, this allegation is deemed Unsubstantiated.

Exit interview conducted. Report signed and delivered.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Joscelyn Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022
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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