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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197606737
Report Date: 11/07/2023
Date Signed: 11/07/2023 01:41:38 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
07/06/2023 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20230706094717
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:
11/07/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Francisca Recede, Administrator TIME COMPLETED:
01:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff inappropriately touch residents
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Angela Panushkina, conducted a subsequent visit to deliver final finding. LPA met with the Administrator and LPA explained the reason for the visit.

At 10:00 AM, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations

During the initial visit made on 07/07/23, LPA Ruiz met with the Administrator and requested client and staff roster. LPA also requested copies of pertinent information which include, but not limited to Physician’s report, Admission Agreement, Appraisal Needs and Services Plan, etc. Between 11:00 AM – 12:15 PM, LPA conducted an interview with the Administrator, two (2) out of four (4) and one (1) out of six (6) residents, who were able to communicate.
Continue on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
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 2
Control Number 31-AS-20230706094717
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: 11/07/2023
NARRATIVE
1
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4
5
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7
8
9
10
11
12
13
14
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20
21
22
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32
Allegation: Staff inappropriately touch residents

It was reported that facility "Staff inappropriately touch residents". To investigate this allegation, during the initial visit conducted by LPA Ruiz on 07/07/23, LPA interviewed the Administrator and two (2) staff involved in R1's care and supervision and all denied the allegation and reported no resident ever complained staff
touched/handled them inappropriately and also they never seen any staff inappropriately touched R1 and or other residents. During today's visit, Administrator reported that all facility staff received training on how to handle residents and that all residents are being treated with care and respect. Based on inspection, observation and interviews there is no sufficient evidence to support the allegation. Therefore, the allegation is Unsubstantiated at this time.

No deficiencies cited. Exit interview conducted, copy of report signed and delivered
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2