Inspection Report
Renewal
Census: 5
Capacity: 6
Deficiencies: 3
Jun 28, 2024
Visit Reason
The visit was conducted as a Renewal Licensing Study for the Golden Haven Foster Home Warren to assess compliance with licensing rules and regulations.
Findings
The facility was found to be non-compliant with several rules including failure to complete an annual health review for direct care staff, missing evening emergency evacuation drills in two quarters of 2023, and lack of a thermometer in the refrigerator to ensure proper food storage temperatures.
Deficiencies (3)
| Description |
|---|
| Direct care staff Matt Angeles did not have an annual health review completed in 2023. |
| No evening emergency evacuation drill conducted in the first and fourth quarters of 2023. |
| No thermometer in the refrigerator to monitor food storage temperatures. |
Report Facts
Capacity: 6
Residents observed: 5
Staff observed: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Matt Angeles | Direct care staff | Named in finding for missing annual health review |
Inspection Report
Complaint Investigation
Census: 5
Capacity: 6
Deficiencies: 2
Nov 4, 2022
Visit Reason
The investigation was initiated due to a complaint alleging that Person B made inappropriate sexual advances toward Resident A at Golden Haven Foster Home Warren.
Findings
The investigation found insufficient evidence to substantiate the sexual advance allegations against Person B. However, violations were established related to Resident A's assessment plan and resident care agreement not being properly signed by her guardian and not reflecting appropriate care instructions.
Complaint Details
The complaint alleged that Person B wanted Resident A to touch his penis and wanted to penetrate her. Resident A reported feeling uncomfortable but did not report the incident previously. Person B denied making any sexual comments. The allegation was not substantiated due to lack of evidence and no witnesses.
Deficiencies (2)
| Description |
|---|
| Resident A's assessment plan dated 06/06/2022 was not signed by her guardian. |
| Resident A's resident care agreement was not signed by her guardian and did not specify that only staff of the same sex can assist her with bathing, dressing, and personal hygiene. |
Report Facts
Capacity: 6
Census: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ellen Angeles | Licensee Designee and Administrator | Interviewed regarding the complaint and facility operations |
| Kristine Cilluffo | Licensing Consultant | Conducted the investigation and authored the report |
Inspection Report
Original Licensing
Capacity: 6
Deficiencies: 0
Dec 2, 2013
Visit Reason
The visit was conducted as an original licensing study for Golden Haven Foster Home Warren to determine compliance with applicable licensing statutes and administrative rules for issuance of a temporary license.
Findings
The facility was found to be in full compliance with all applicable licensing rules and regulations for small group homes. No rule or statutory violations were noted. The home is suitable for six residents and a live-in caregiver, meeting all physical, safety, and programmatic requirements.
Report Facts
Capacity: 6
Square footage: 2800
Fire drills required: 12
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ellen Angeles | Licensee Designee | Licensee designee authorized to conduct business and make decisions on behalf of the company |
| Alexander Angeles | Administrator | Appointed administrator responsible for facility operations |
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