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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850262
Report Date: 07/06/2023
Date Signed: 07/06/2023 03:35:50 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/27/2023 and conducted by Evaluator Angel Ascencio
COMPLAINT CONTROL NUMBER: 29-AS-20230627095514
FACILITY NAME:QUORA CAREFACILITY NUMBER:
195850262
ADMINISTRATOR:GOCHIN, RHODAFACILITY TYPE:
740
ADDRESS:22806 CALIFA STREETTELEPHONE:
(747) 230-8689
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:6CENSUS: 4DATE:
07/06/2023
UNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Tsiana MikiaTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Uncleared adult present in facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angel Ascencio conducted an inital complaint investigation to the above facility. LPA Ascencio met with staff at 02:10 p.m. Staff stated there is not current administrator and that the owner Grace Vimala is the person to talk to.

On 06/27/2023, the Department received a complaint regarding uncleared adult present in facility. On 07/06/2023, LPA Ascencio conducted an interview with owner Grace Vimala at 02:54 p.m. Grace stated they do not have a staff member working at the facility with the name of Gbolabo ‘Labo’ Folayan. Grace added that "Labo" does assist when in need of house supplies. Lastly, Grace stated they were unaware that "Labo", who since January 2019, has been excluded from having any authority to operations at any facility.

LPA Ascencio conducted a review of the Caregiver Background Check System revealing that Mr. Folayan is excluded.
Continued on LIC 9099 - C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel AscencioTELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023
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 3
Control Number 29-AS-20230627095514
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: QUORA CARE
FACILITY NUMBER: 195850262
VISIT DATE: 07/06/2023
NARRATIVE
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Information obtained from today's interviews confirmed claims that Mr. Folayan had been observed inside the facility and has worked in the capacity of communicating with and placing residents at this location, in addition to being the person "in charge" of the caregivers.

The Department obtained a Decision and Order effective 01/19/2020 excluding Gbolabo "Labo" Folayan from being a licensee, owning beneficial ownership interest of 10 percent or more in a licensed facility, or being an administrator, officer, director, member, or manager of a licensee or entity controlling a licensee and further, from employment in, presence in, and from contact with clients of, of any facility licensed by the Department, for the remainder of their life.

Based on the information obtained and the interviews conducted, there is sufficient evidence to support the claim that Gbolabo "Labo" Folayan, whom is excluded, has been present at this facility since the Decision and Order went in effect 01/19/2020. The allegation, uncleared adult present in facility is deemed substantiated at this time.

Per the California Code of Regulations (CCR), Title 22, Division 6, Chapter 8, the following deficiencies are cited: (Refer to LIC 9099-D). Civil penalties assessed.

SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel AscencioTELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20230627095514
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: QUORA CARE
FACILITY NUMBER: 195850262
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/07/2023
Section Cited
CCR
1569.58(a)(2)
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§1569.58(a)(2) The department may prohibit any person from being a licensee … an administrator … and ... prohibit any licensee from employing … or allowing contact with clients of a licensed facility … who has done … the following: (2) Engaged in conduct that is inimical to the health ... welfare, or safety ...
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The Administrator has agreed to do the following:
Review Health and Safety Code 1569.58 and Regulation 87355 with all staff. Submit Statement of Understanding and sign-in sheet, acknowledging review, by 7/7/2022
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This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above, as an excluded individual has been seen in the facility and has had regular contact with clients, which poses an immediate health,safety and personal rights risk to residents in care.
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Zero tolerance violation, civil penalties assessed in the amount of $500.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel AscencioTELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3