195850090-4-11-2025-29-AS-KLOZ-DG83ST-20250429183053

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850090
Report Date: 04/10/2025
Date Signed: 04/11/2025 07:55:15 AM

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
10/02/2024 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20241002090219

FACILITY NAME:	SUNSHINE RESIDENTIAL HOME BALBOA		FACILITY NUMBER:	195850090
ADMINISTRATOR:	JOSE, OYINLOYE AUSTINE		FACILITY TYPE:	735
ADDRESS:	7431 JELLICO AVENUE		TELEPHONE:	(818) 274-1809
CITY:	LAKE BALBOA	STATE: CA	ZIP CODE:	91406
CAPACITY:	4	CENSUS: 3	DATE:	04/10/2025
		UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Toluwalope Jose		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility staff hit resident.
Facility staff searched resident’s belongings without consent.
Facility staff are not following resident’s needs and services plan.
Facility did not prevent resident from smoking inside the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced subsequent visit to deliver the findings for the allegations listed above. The staff greeted the LPA and contacted the Administrator on the phone. The LPA read the report to the Administrator over the phone and allowed the facility representative Keyollete Wilsen to sign the report.
On 10/09/2024, LPA Urena interviewed residents and Administrator from approximately 10:55 a.m. to 12:30 p.m. Documents pertinent to the investigation were collected.
Facility staff hit resident.
On the allegation that facility staff hit resident, it is the concern of the RP that a resident (R2) claimed that they saw a staffrecord hit R1. To investigate the allegation, LPA Urena interviewed R2 on 10/09/2024 about the incident they reported to the RP. The R2 communicated with the LPA via their one- to -one companion. At the time of the interview, the R2 did not have information for the LPA about the incident they had allegedly witnessed. The R2 stated that staff are nice. Continues on LIC 9099C...pg2

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025

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 4

Control Number 29-AS-20241002090219

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: SUNSHINE RESIDENTIAL HOME BALBOA	FACILITY NUMBER: 195850090
	VISIT DATE: 04/10/2025

NARRATIVE

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Pg. 2
The LPA attempted to interview R1 about the incident, but R1 declined to speak to the LPA, however R1 did state that no one hit them and they don’t want to waste their time speaking with the LPA. The LPA interviewed the Administrator about the incident, and the Administrator stated that they became aware that S1 had hit R1 through a telephone call with R1’s provider. The Administrator interviewed and R1 denied S1 hitting them and stated that they did not like S1 and wanted another one-to one. No other residents have reported that S1 was physical with them. The LPA was unable to reach S1 for an interview. The LPA interviewed the RP on 10/07/2024 about the incident reported by R2 to the RP. The RP stated that R2 could not provide specifics (time, date, place) about the incident, furthermore the RP stated that R2 stays mostly in their room with their private companion. Per the RP, they interviewed R1 about the incident reported by R2. The RP asked R1 if this has happened in the past? and R1 stated, "no. not really". R1 said that they had come back from the community, when S1 decided to search R1's backpack, R1 tried to stop S1 from searching the bag, and this is when according to R1, S1 hit them in the back. The LPA interviewed additional residents, and the residents stated that S1 has always been nice to them.

Although the allegation may have happened or is valid, based on the information gathered through interviews there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Facility staff searched resident’s belongings without consent.
On the allegation that Facility staff searched resident’s belongings without consent. it is the concern of the RP that the facility staff searched R1’s belongings without consent. LPA Urena interviewed the RP, and the RP said that through an interview done with R1, R1 claimed that staff was going through their backpack when R1 returned to the facility after an outing. Furthermore, the RP said that R1 claimed that they (R1) likes to steal; therefore, staff search R1’s backpack when R1 returns from the community outings. The Administrator’s interview revealed that R1 likes to go out to the community on their own, and often R1 will bring back weapons and other items (drugs) that may be dangerous to R1 and to the other residents in the facility.

Continues on LIC 9099C...Pg 3

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 29-AS-20241002090219

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: SUNSHINE RESIDENTIAL HOME BALBOA	FACILITY NUMBER: 195850090
	VISIT DATE: 04/10/2025

NARRATIVE

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Pg.3
Per the Administrator, staff always ask for permission to search R1’s backpack after their outings. LPA attempted to interview R1 about this allegation, but R1 declined the interview. The LPA interviewed the rest of the residents about staff searching their personal items without their consent, and the residents stated that they have not had that experience. The LPA interviewed staff, and staff denied searching residents personal belongings without their permission. On 10/10/2024, the LPA communicated with R1’ s Consumer Service Coordinator (CSC) about the allegation and the CSC stated that R1 has some safety issues while out in the community. R1 is known to bring into the home knives, marijuana, lighters and other toxic items. As part of R1’s behavioral plan the staff would regularly clean up R1’s room and remove toxic items or other prohibited items that R1 has in their possession. This does not normally go down well with R1.

Although the allegation may have happened or is valid, based on the information gathered through interviews and record review, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Facility staff are not following resident’s needs and services plan.
On the allegation that Facility staff are not following resident’s needs and services plan, it is the concern of the RP that R1 is supposed to have a one-to-one staff. Per RP, R1 is supposed to have a care plan requires a one-on-one staff, however when the RP questioned facility Administrator about it, the administrator told the RP that R1 doesn’t have a one-on-one staff assigned to them anymore, because "the authorization ended in June" . The Administrator provided the LPA with documentation which states that the one to one service had ended. On 10/10/2024, the LPA interviewed R1’s Consumer Service Coordinator (CSC) from the North Los Angeles County Regional Center (NLACRC). The CSC confirmed that the one-to-one services for R1 had been terminated because the 1:1 service was not productive anymore. A meeting has been scheduled to follow up and to evaluate the services that can best service R1's needs.

Based on the information gathered through interviews and record review, the facility is following the resident’s needs and services plan. Therefore, the allegation is deemed Unsubstantiated, at this time.

Continues on LIC 9099C... pg 4.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20241002090219

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: SUNSHINE RESIDENTIAL HOME BALBOA	FACILITY NUMBER: 195850090
	VISIT DATE: 04/10/2025

NARRATIVE

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Pg 4.
Facility did not prevent resident from smoking inside the facility.
On the allegation that the Facility did not prevent resident from smoking inside the facility, itt is the concern of the RP that they asked staff about R1 smoking and staff reported R1 has smoked marijuana in their bedroom before and staff said they were unable to stop R1. The interview with the Administrator revealed that they do indeed have a concern with R1 smoking in their room, and anytime staff notice the smoke they remind R1 about the house rules about smoking, The Administrator stated that staff documents the smoking incidents, however staff do what is within their scope to remind R1 about the smoking rules in the facility, and try to remedy immediately when they notice R1 is smoking in their room. The interview with R1’s CSC revealed that R1 appears to have a substance abuse problem, and they will recommend at R1’s service plan meeting that R1 be admitted to a facility to assist with substance abuse.

Based on the information obtained through interviews, it is apparent that R1 sometimes chooses to smoke inside the facility, specifically in their private room. However, the facility staff do remind R1 about the house rules and ask R1 to smoke outside when they notice that R1 is smoking in their room. Therefore, the allegation that facility did not prevent resident from smoking inside the facility, deemed Unsubstantiated at this time.

No citations were issued. Exit interview was conducted and copy of the report was issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025

LIC9099 (FAS) - (06/04)

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