565801311-4-30-2025-29-AS-KBUY-DJ62S7-20250630173841

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801311
Report Date: 04/30/2025
Date Signed: 04/30/2025 01:31:30 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
09/06/2024 and conducted by Evaluator Teresa Camara

COMPLAINT CONTROL NUMBER: 29-AS-20240906101058

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: 5	DATE:	04/30/2025
		UNANNOUNCED	TIME BEGAN:	09:59 AM
MET WITH:	Bonnie Haave		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff are not providing adequate food service to residents
Staff left resident in soiled diapers for extended periods of time
Staff are not responding to residents' call buttons in a timely manner
Staff made inappropriate comment towards resident
Staff are not communicating with resident's authorized repsresntative regarding resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint investigation visit. LPA met with administrator Bonnie Haave and explained the reason for the visit.

On 9/11/2025, LPA interviewed a resident, witness, and administrator. LPA conducted a facility tour and inspected the food supply. LPA reviewed and obtained pertinent documents. On 4/29/2025, LPA interviewed another witness over the phone. During today's visit on 4/30/2025, LPA interviewed a witness at 11:14 a.m., staff at 11:04 a.m., and the administrator at 10:00 a.m. LPA reviewed and obtained pertinent documents at 10:30 a.m.

(continued on 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2025

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 29-AS-20240906101058

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: HAAVE HOUSE	FACILITY NUMBER: 565801311
	VISIT DATE: 04/30/2025

NARRATIVE

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(continued from LIC9099; page 1)

Regarding the allegation staff are not providing adequate food service to residents:
LPA observed a sufficient food supply. LPA asked residents about food service and they responded "good" and "it's delicious". The administrator showed LPA slips of paper Resident 1 (R1) would write their requests for what they wished to be served and staff would accommodate R1's requests. LPA interviewed witnesses who stated staff were very accommodating to R1's wishes, although R1 frequently complained about what they were served, even though it was what R1 requested. Based on interviews and the food supply inspection, this allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation staff left resident in soiled diapers for extended periods of time:
LPA interviewed witnesses who observed and provided care to R1. They stated they had not observed R1 with soiled diapers when they visited R1. In addition, they had not observed any skin breakdown which would be indicative of being left in soiled diapers. Based on these interviews, this allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation staff are not responding to residents' call buttons in a timely manner:
LPA interviewed a resident who stated they would hear R1 ring their bell/call button and staff would respond right away. Witnesses stated they observed the same. Staff stated when R1 rang they checked on R1 right away. They would also check on R1 regularly without the bell but if R1 didn't ring, or accidentally rang, R1 would get irritated with them and yell and sometimes strike staff. Based on these interviews, this allegation is deemed UNSUBSTANTIATED at this time.

(continued on LIC9099-C; page 3)

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20240906101058

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: HAAVE HOUSE	FACILITY NUMBER: 565801311
	VISIT DATE: 04/30/2025

NARRATIVE

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(continued from LIC9099; page 2)

Regarding the allegation staff made inappropriate comment towards resident:
LPA interviewed a resident and witnesses about how staff communicated with R1. The resident and witnesses stated staff were always kind and respectful to R1, even when R1 was yelling at them. Staff stated they were kind and patient to R1. If R1 was being too aggressive toward them they would leave her alone to let her calm down as she would threaten to strike them with the TV remote or possibly a flashlight. These threats would be due to staff coming into R1's room to check on them without R1 pressing the call button. Staff regularly check on residents to see if they need assistance with incontinence care or if the want a snack or something to drink. Based on this information, this allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation staff are not communicating with resident's authorized representative regarding R1:
LPA reviewed text messages sent to the administrator regarding R1 from R1's family. Many of the text messages were sent to the administrator after her normal business hours. The administrator informed the family of her normal business hours of 11:00 a.m. to 4:00 p.m. Most of the text messages were sent outside of those hours and were non emergent. The text messages were responded to later or they were followed up with a phone call. Based on this information, this allegation is deemed UNSUBSTANTIATED at this time.

No deficiencies observed. Exit interview conducted and copy of the report issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2025

LIC9099 (FAS) - (06/04)

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