Haven Homes

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with staff, Aniyah Williams, and explained the reason for the visit. At approximately 9:30am, with ith the assistance of staff, LPA took a tour of the physical plant. The facility is a one story building. Required postings were observed in the entry area. The smoke alarms are battery operated. The carbon monoxide detector is installed in the living room. Both were tested and functional during visit.. The fire extinguisher located in the kitchen. It was charged July 2025. Emergency evacuation drill was last conducted on September 18, 2025 Kitchen: The kitchen appliances and fixtures are functional. LPA found a sufficient amount of perishable and non-perishable food properly sealed and stored. Knives are stored in a locked drawer in the kitchen. Cleaning supplies are locked in a cabinet underneath the kitchen sink. Bedrooms: There are four (4) bedrooms designated for residents' use. At this time, all bedrooms are occupied for private use. Bedrooms were observed to be properly furnished with appropriate beddings and linens with sufficient lighting. Passageways going in and out of the rooms were clear of obstruction. Bathrooms: There are two (2) bathrooms designated for residents' use. Both bathrooms were properly supplied and had functional fixtures, grab bars and non-skid mats. No cleaning supplies were observed in either of the bathrooms. Hot water temperature measured at 110 degrees. Common Areas: These included the living room and dining area. The living room has sufficient seating with a couch and chairs Living room is also furnished with tables and a television. There is no fireplace. The dining table is large enough to seat up to six (6) residents. The auditory alarms on all exit doors were on and functional at the time of the visit. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. There is a storage building, in the backyard, which was checked and locked. There is no swimming pool or any other bodies of water. Laundry Area: The laundry area is located by the kitchen. No detergents, fabric softener or cleaning supplies were observed out during the day's inspection. Garage: Garage is converted into staff room. Staff Room/Work Station: Staff room is located next to the laundry area. It's kept locked and inaccessible to the residents in care. Resident Files: Resident files are kept locked in a cabinet by the living room. LPA conducted a file review of resident records to insure compliance of licensing forms. Staff Files: Resident files are kept locked in a cabinet by the living room. LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. Medications: Medication cabinet is located by the dining room. Medication and Medication Records were reviewed for proper storage, locks and documentation. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.the state’s words, verbatim · CDSS document, Oct 21, 2025

Allegation investigated: Questionable Death. Staff did not respond to resident's requests for assistance in a timely manner.

Licensing Program Analyst (LPA) Michael Cava conducted a subsequent complaint visit to the facility to conclude the investigation regarding the above allegations. LPA met with staff, Aniyah Williams, and advised her of the complaint. During the course of this investigation, interviews with the administrator, staff and residents were made. LPA conducted a physical plant inspection of the facility to insure the health and safety of the residents. LPA also obtained medical records pertaining to the above allegations. Questionable Death: In regards to the allegation, it was reported that Resident 1 (R1) experienced a fall on or around August 27, 2024. R1 was transported to the hospital and admitted for observation on the same day. R1 was diagnosed with a subdural hematoma. On or around August 30, 2024, R1 was discharged to return to the facility. On or around September 5, 2024, R1 was found unresponsive. R1 was sent back to the hospital, and passed away on September 9, 2024. It’s being alleged that R1’s fall, which resulted to the subdural hematoma Unsubstantiated caused or contributed to R1’s death. Interview with facility administrator confirms that R1 had a fall, resulting in subdural hematoma on or around August 27, 2024. The administrator also confirms that R1 was found unresponsive on or around September 5, 2024, and passed away on September 9, 2024. The administrator denies that R1’s fall, leading to the subdural hematoma, contributed to R1’s death. The administrator stated R1’s current diagnoses and condition contributed to the cause of death. Review of R1’s records indicate that R1 was already taking medications to prevent heart attack and stroke. R1’s physical health status when admitted on January 27, 2023, was marked fair by the physician. Per death certificate, cause of death was stroke and hypertension. On April 21, 2025, LPA Cava requested for a Program Clinical Consultant (PCC) review to confirm if the subdural hematoma, contributed to R1’s death. On August 11, 2025, PCC completed their review. The following was revealed and PCC concludes: · R1 already had some chronic conditions with a history of stroke at admission to the facility. · Given R1’s medical history, R1 had multiple coexisting conditions that made R1 prone to bleeding and increased risk for stroke. · “According to CDC, previous stroke or transient ischemic attack increases the chances of having another stroke.” · During a follow up appointment on September 4, 2024, there was no concern about further bleeding or any signs of stroke. Based on this information obtained and a review conducted by PCC, there is insufficient evidence to prove that R1’s fall, which resulted in subdural hematoma, contributed to R1’s death. Therefore, the allegation of Questionable Death, is deemed Unsubstantiated at this time. Staff did not respond to resident’s requests for assistance in a timely manner: In regards to the allegation, it was reported that R1 was instructed to yell out for staff when requesting for assistance, instead of using the call button provided. Interview with the administrator deny the allegation. Administrator stated R1 and all facility residents are provided a portable push button device to carry with them to activate when assistance needed. On August 27, 2024, R1 had a fall, that caused damage to the portable push button device. Because of the damage to the device, R1 had to yell out for help. Staff did come to assist R1. Paramedics were called and R1 was taken to the hospital. LPA was unable to interview Staff 1 (S1), as S1 no longer works at the facility. Interview with three (3) of three residents could not corroborate with the allegation of having to yell for staff assistance. LPA conducted a physical plant inspection, and observed a push button device, provided to each resident in care. A test of this device proves to be functional. According to the three residents that were interviewed, there were no issues when utilizing this device. Based on the information obtained, the allegation of staff not responding to resident requests for assistance in a timely manner could not be proven. Therefore, the allegation is deemed Unsubstantiated at this time.the state’s words, verbatim · CDSS document, Aug 29, 2025 · control 31-AS-20241121154006

Allegation investigated: Staff did not safeguard resident's personal possessions while in care.

Licensing Program Analysts (LPAs) Nadia Shahbazian and Michael Cava conducted a subsequent visit to the facility to close out the investigation regarding the above allegation. LPAs met with the administrator, Jessica Horowitz, and advised her of the complaint. Today's investigation consisted of interviews with the administrator, staff and residents. LPAs also conducted a record review and physical plaint inspection. In regards to the allegation, it was reported that while Resident 1 (R1) lived at this facilty, some of their personal money went missing. Interviews with the administrator reveal that the facility does not handle resident cash. Administrator stated she did file an Incident Report (IR), pertaining to R1 missing money on or around March 22, 2024. R1's responsible person was notified, and the administrator filed a police report. Law Enforcement were unable to file a report since there was no evidence or proof of the exact amount taken. According to the administrator, she had no knowledge that R1 was keeping cash with them in their room, as it was never reported to her. Moreover, R1 never made an entry on their Client/Resident Personal Unsubstantiated Property and Valuables (Form LIC 621). Review of R1's file reveal that this incident was reported by the administrator on 03/22/24. Further review of R1's file also confirm that R1 did not make an entry on their LIC 621 for cash. Interviews with residents also do not corroborate with the allegation of staff failing to safeguard their personal belongings. Based on the information obtained, there was insufficient evidence to prove that staff did not safeguard R1's personal possession while in care. Therefore, the allegation is deemed Unsubstantiated at this time.the state’s words, verbatim · CDSS document, Dec 5, 2024 · control 31-AS-20241121154006

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Nadia Shahbazian and Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the administrator, Jessica Horowitz, and explained the reason for the visit. With ith the assistance of the administrator, LPAs took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are battery operated. The carbon monoxide detector is installed in the living room. It functions properly. The fire extinguisher located in the kitchen is fully charged. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Cleaning supplies are locked underneath the kitchen sink. Bedrooms: There are four (4) bedrooms designated for residents' use. The bedrooms that are occupied by the residents were properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are two (2) bathrooms designated for residents' use. Both bathrooms were properly supplied and had functional fixtures. LPAs did not observe any cleaning supplies or hazardous items stored in either of the bathrooms in use by the residents. Hot water temperature signs compliant with regulation. Common Areas: These included the living room and dining area. The living room had a couch, two tables and a television. The dining room table is large enough to seat up to six residents. Passageways and hallways were clear obstruction. Floors were mopped and clean. The auditory alarms on all exit doors were on and functional at the time of the visit. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. There is a storage building, in the backyard, which was checked and was locked. Laundry Area: The laundry area is located by the kitchen. LPA did not observe detergents to be accessible at the time of the visit. Garage: Facility does not have a garage. It was converted into staff room. Staff Room/Work Station: Staff room is located next to the laundry area. Staff room is inaccessible to the residents in care. Resident Files: Resident files are kept locked in a cabinet by the living room. LPA conducted a file review of resident records to insure compliance of licensing forms. Staff Files: Resident files are kept locked in a cabinet by the living room. LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. Medications: Medication cabinet is located by the dining room. Medication and Medication Records were review for proper storage, locks and documentation. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.the state’s words, verbatim · CDSS document, Dec 5, 2024