Senior Care Records.

Complaint Investigation Report

Haven Care Home LLC, Vallejo02/15/2024Licence 486804040

Census1
Date signed02/15/2024 09:07:30 AM
The inspector’s account

486804040-2-15-2024-21-AS-VBEI-D2J2JH-20240216162621

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1450 NEOTOMAS AVENUE, STE. 100

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

01/30/2024 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20240130110131

Licensing Program Analyst Leibert arrives unannounced for the purpose of delivering findings on this complaint. During the course of this investigation, site visits were made, as well as statements taken and documents reviewed. The following determinations are made: On or about 1/29/2024, C1 began yelling, slamming doors, and throwing objects at facility staff; C1's behavior escalated to threats of physical violence against staff; C1 exited the facility to wait for C1's bus and began throwing rocks at the house, car and Administrator; Administrator called Police and Regional Center Crisis staff for assistance and did lock the door to prevent C1 from entering the facility to carry out threats of violence against staff and or another client in care. Client witness states that C1 was not hit by the door closing and that C1 was aggressive and making threats to staff. Although the allegations may be true, based on statements and documents, there is not a preponderance of evidence to prove or, disprove, the allegations. Therefore, the allegations are UNSUBSTANTIATED.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction