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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197606737
Report Date: 02/17/2023
Date Signed: 02/17/2023 04:06:25 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
02/16/2023 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20230216151634
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: 6DATE:
02/17/2023
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Francisca Recede, Administrator. TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff forced residents to take cold showers
Staff handled residents in a rough manner
Staff utilized toilet water to clean residents
Staff do not ensure that residents are adequately fed
INVESTIGATION FINDINGS:
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At approximately, 12:30pm Licensing Program Analyst (LPA), Angela Panushkina arrived to this facility in response to the above mentioned allegations. LPA met with the Administrator and explained the reason for the visit.

LPA conducted a physical plant walk through, at approximately 12:40pm, to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. LPA did not observe any immediate health and safety issues during the visit.

LPA conducted interview with the Administrator, three (3) staff members, four (4) out of six (6) residents, who were able to communicate, between 12:45pm to 2:10pm and reviewed facility records. LPA also obtained copies of pertinent documents relevant to the investigation.

Continue on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023
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 31-AS-20230216151634
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: A HEAVENLY HAVEN, INC. II
FACILITY NUMBER: 197606737
VISIT DATE: 02/17/2023
NARRATIVE
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Allegation:Staff forced residents to take cold showers

To investigate this allegation, LPA conducted an interview with the Administrator and three (3) staff members and was informed that the facility provides showers every other day (in the morning 7:00am). LPA was informed that before the shower is provided, the staff has to adjust the water temperature and that all residents get showers with warm water. In addition. In addition, LPA conducted an interview with four (4) out of six (6) residents, who were able to communicate, and all four (4) residents confirmed that the facility provides warm showers every other day. Lastly, LPA tested the hot water temperature at 2:00pm and it was measured at 120°F. Based on information obtained through interviews this allegation is deemed Unsubstantiated.

Allegation: Staff handled residents in a rough manner

To investigate this allegation, LPA conducted an interview with the Administrator and three (3) staff members and was informed that the staff always takes care of their residents with dignity and respect. All staff denied ever taking care of the residents in a rough manner. In addition, interviews with four (4) out of six (6) residents revealed that they are being treated very well and staff handles them with care. Based on information obtained through interviews this allegation is deemed Unsubstantiated.

Allegation: Staff utilized toilet water to clean residents

Interview with the Administrator and three (3) staff members revealed that the facility never utilized toilet water to clean residents. All staff members informed LPA that in case of an accident the resident will be provided with the shower from waist down (inside the shower) and or full shower, as needed. In addition, four (4) out of six (6) residents denied ever being cleaned with a toilet water. Based on information obtained through interviews this allegation is deemed Unsubstantiated.

Continue on LIC9099-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20230216151634
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: A HEAVENLY HAVEN, INC. II
FACILITY NUMBER: 197606737
VISIT DATE: 02/17/2023
NARRATIVE
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Allegation: Staff do not ensure that residents are adequately fed

Regarding the allegation that staff do not ensure that residents are adequately fed, LPA conducted interviews with four (4) out of six (6) residents, who were able to communicate, and was informed by four (4) residents that they believe they are adequately fed. LPA record review and observation also revealed that the facility provides complete meal with fruit and vegetable servings on every meal and staff interview revealed that the staff responsible for cooking also customize food being served upon resident's request. Moreover, LPA was informed that the weekly menu may vary and daily menu provides options and alternate option for the residents to choose. Based on the information gathered during this visit, this allegations is deemed Unsubstantiated at this time.

No deficiencies issued during todays visit.

Exit interview conducted and copy of this report signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3