Complaint Investigation Report

197609720-4-22-2022-31-AS-CHAS-CE4TNZ-20220504145333

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 21731 VENTURA BLVD., STE. 250

This is an official report of an unannounced visit/investigation of a complaint received in our office on

08/09/2021 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20210809140504

HAVENS AT ANTELOPE VALLEY ASSISTED LIVING, THE

Staff failed to provide a safe environment for the residents.

LPA Spaeth conducted an unnanounced visit to the facility and was greeted by Administrator, M. Mendoza-Perry. LPA stated the purpose of the visit was to conclude the investigation of the complaint which states illegal eviction, staff failed to provide a safe environment for the residents, staff failed to meet residents' needs, and facility failed to issue a refund.

In regard to the allegation, staff failed to provide a safe environment for the residents, LPA Spaeth interviewed the complainant on 8/12/2021. Complainant stated received a call from facility staff on July 22, 2021 stating resident (R1) had left the facility through a fire exit door that had been left open by construction workers. LPA interviewed staff member (S1) on 8/12/2021 who found R1 outside one block from the facility. S1 stated had gone to R1's room for med. distribution but found R1 was gone. S1 then found door was open and should have been closed. LPA viewed Physician's Report which states resident should not leave the facility without assistance. Based on the information obtained this allegation is deemed Substantiated. Deficiency cited on LIC 9099 D. Appeal rights were discussed, exit interview conducted, and a copy of the report was given to the Administrator.