197606745-1-12-2026-31-AS-NMAN-DSK6YQ-20260326211355

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606745
Report Date: 01/12/2026
Date Signed: 01/12/2026 02:07:36 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/02/2026 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20260102192319

FACILITY NAME:	AMAZING GRACE HOME CENTER II		FACILITY NUMBER:	197606745
ADMINISTRATOR:	GRACE O. OYEBOBOLA		FACILITY TYPE:	735
ADDRESS:	8539 GOTHIC AVENUE		TELEPHONE:	(818) 221-3015
CITY:	NORTH HILLS	STATE: CA	ZIP CODE:	91343
CAPACITY:	4	CENSUS: 4	DATE:	01/12/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	GRACE O. BAJOMO- Licensee		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Staff do not ensure that client's healthcare needs are met.
Staff falsified client records.
Staff mismanaged client funds.
Staff are not providing adequate food service.
Staff are not adequately trained.
Staff do not provide residents daily activities.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Leslie Ngo-Castaneda conducted an initial complaint visit to the facility to investigate the above allegation. LPA met with the licensee, Grace Bajomo, and advised them about the visit.

An entrance interview was conducted.

To investigate the allegation, at 9:35 AM, LPA conducted a physical plant tour to ensure the health and safety of the clients in care. LPA interviewed one (1) client and four (4) staff (including the licensee) from 10:43 AM to 12:15 PM. At 12:20 PM, LPA reviewed and received copies of documents related to the investigation, including the staff roster (LIC 500), resident roster (LIC 9020), Client #1 (C1’s) physician report, identification and emergency information, C1's IPP, staff training records, and other relevant documents.
Continue to LIC 90990-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20260102192319

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: AMAZING GRACE HOME CENTER II	FACILITY NUMBER: 197606745
	VISIT DATE: 01/12/2026

NARRATIVE

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Allegation #1: Staff do not ensure that the client’s healthcare needs are met.

It was alleged that client #1 (C1) did not receive any medical or dental visits for seven months. Staff interview revealed that Staff #1 (S1) takes clients to their medical/ dental appointments or urgent care when needed. LPA attempted to interview clients, but they were non-verbal. LPA observed the clients to be healthy and well. A review of facility clients medical appointment records verified the information revealed from the interview.

Based on interviews and record review, there is insufficient information to support the allegation. Therefore, this allegation is deemed Unsubstantiated at this time.

Allegation #2: Staff falsified client records.

It was alleged that the facility licensee falsified clients’ records, including physician reports for C1 and client #2 (C2). Staff interviewed revealed that they would never falsify records of clients. LPA reviewed client's records, and it was observed that the client's physician reports (LIC 602 A) are stamped and signed by a licensed vendor physician from NLACRC. LPA observed and reviewed clients’ after-visit summary (AVS) from the hospital and/or emergency rooms. A review of facility records verified the information revealed from the interview.

Based on interviews and record reviews, there is no sufficient information to support the allegation. Therefore, this allegation is deemed Unsubstantiated at this time.

Allegation #3: Staff mismanaged client funds.

It was alleged that the facility staff are financially mismanaging clients' funds, including funds received from C1’s family. An interview with the licensee revealed that the facility does not receive full payment from NLACRC and that the C1 family had to pay the remaining balance from C1's Social Supplementals Income (SSI) managed by C1’s family. A review of C1’s admission agreement verified that C1’s cash resources, including their Personal and Incidental (P&I) funds are handled by their family. A telephonic interview with C1 family today at 12:24 PM revealed that they are the guardian for C1, and they have no financial issue with the facility.Based on observations, interviews, and record review, C1’s funds are not being mismanaged. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.
Continue to LIC 9099-C

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2026

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20260102192319

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: AMAZING GRACE HOME CENTER II	FACILITY NUMBER: 197606745
	VISIT DATE: 01/12/2026

NARRATIVE

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Allegation #4: Staff are not providing adequate food service.

It is alleged that C1’s family provided funds for food, but no take-out was ever ordered, and expired food was routinely served. During LPA’s facility tour, LPA Ngo-Castaneda observed that proper food storage was maintained in the refrigerator and pantry. Expiration dates were clearly indicated on all the items. LPA observed that all the contents of the food did not contain mold. LPA observed that the non-perishable and perishable food items are fresh and not expired. LPA observed the refrigerator and pantry to be fully stocked.
Staff interview unanimously confirmed that the staff have never served expired food. The staff also confirmed that the food in the refrigerator and in the canned goods cabinet is checked daily by staff. All expired food is discarded. LPA was not able to interview clients since they are non-verbal and unavailable at the facility. Based upon staff interviews and LPA's observations, the allegation is unsubstantiated.

Allegation #5: Staff are not adequately trained

It is alleged that staff are not adequately trained to handle/assist clients and staff are not allowed to attend free DSP training. Staff interview revealed that they are trained before being onboard to the facility. LPA interviewed Licensee (S1) who stated that staff are required to be trained to be on-boarded and assist clients for their needs and care. An interview with three (3) staff members revealed that they attended all necessary vendor training from NLACRC to work at the facility. LPA reviewed training records showed that staff are trained and have DSP training from NLACRC. Therefore, based on observations, record review and interviews, this allegation is deemed unsubstantiated at this time.

Allegation #6: Staff do not provide clients with daily activities

It is being alleged that clients were provided with daily activities. Staff is not following the activities as posted on activity schedule. During LPA's interview with four (4) staff, they all confirmed that all clients are provided with different activities. Some clients are very tired from attending the day program, they skip activities offered at home or they prefer to just go for a stroll within the area. A review of activity schedule revealed that facility offers different activities based on clients’ ability. Based on interviews and record review, there is no pertinent information to verify the allegation. Therefore, the allegation(s) are UNSUBSTANTIATED at this time.
An exit interview was conducted, and a copy of the report was given to the licensee.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2026

LIC9099 (FAS) - (06/04)

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