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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197606938
Report Date: 07/07/2026
Date Signed: 07/07/2026 02:36:29 PM

Substantiated


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
07/02/2026 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20260702115847
FACILITY NAME:AUTUMN HILLS RESIDENTIAL HOME, INC.FACILITY NUMBER:
197606938
ADMINISTRATOR:AUGUSTINE KEHINDEFACILITY TYPE:
740
ADDRESS:43129 LEMONWOOD DRIVETELEPHONE:
(661) 943-8194
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:6CENSUS: 4DATE:
07/07/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Augustine Kehinde - AdministratorTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Staff did not prevent exit doors form being blocked
Staff do not keep the facility maintained
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Evelin Rios and Licensing Program Manager (LPM) Mary Flores conducted an unannounced complaint visit at this facility for the above allegations. LPA was greeted and granted access by a staff member. The administrator, Augustine Kehinde met LPA and LPM shortly after. LPA explained the reason for the visit. An entrance interview was conducted.

The investigation consisted of the following: LPA initiated a physical plant tour of the facility to ensure the health and safety of residents in care. While conducting the tour, from 9:10 a.m., to 10:40 a.m., LPA interviewed four (4) out of four (4) residents and two (2) staff. At approximately, 11:45 a.m., LPA and LPM interviewed the administrator. LPA obtained and reviewed copies of the facility's resident roster, personnel report (LIC 500), residents' admission agreements, residents', physician's reports, and Resident Personal Property and Valuables document.
The investigation revealed the following: Regarding allegation: Staff did not prevent exit doors from being blocked. It is alleged that an exit door is blocked with objects. (Continue to LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026
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 7
Control Number 31-AS-20260702115847
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: AUTUMN HILLS RESIDENTIAL HOME, INC.
FACILITY NUMBER: 197606938
VISIT DATE: 07/07/2026
NARRATIVE
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The investigation revealed the following:

Regarding the allegation: Staff yell at residents. It is alleged that staff scream and curse at the residents. LPA’s interviews with two (2) staff members stated they have not yelled at residents nor witnessed any staff yelling or curse at residents. One (1) staff member stated that they have a loud voice but are not yelling at residents. Interview with the administrator denied the allegation, stating staff have training regarding personal rights and know not to do that. LPA’s interviews with four (4) out of (4) residents denied the allegation, stating staff have not yelled or cursed at them and they have not witness staff yelling at other residents. One (1) resident stated that they do not like the attitude of one (1) staff member but did not wish to elaborate.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Regarding the Allegation: Staff are not meeting residents laundry needs. It is alleged that bed sheets and laundry haven’t been done for weeks. LPA’s interviews with two (2) staff members stated they schedule laundry service twice a week and as needed. One (1) staff member stated that they will wash bedding and resident’s clothes right away if someone has had an accident and that there is a resident that may refuse their bed sheets changed. LPA’s interviews with four (4) out of (4) residents reported that staff take care of laundry service and have no concerns regarding laundry.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Regarding the allegation: Staff are not meeting residents bedding needs. It is alleged, that residents have stains on their sheets that have been there for three weeks. LPA’s interviews with two (2) staff members stated they change bedding once a week or as needed. One (1) staff member stated that one (1) resident may refuse their bedding changed and another resident requires frequent bedding changes. LPA’s interviews with four (4) out of (4) residents reported that staff change their bedding. One (1) resident stated that they prefer to make their own bed and that their bed sheets were changed two days ago. Another resident reported their bed sheets were changed yesterday.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

(Continue to LIC9099-C) Page 2 of 4

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 7
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
07/02/2026 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20260702115847

FACILITY NAME:AUTUMN HILLS RESIDENTIAL HOME, INC.FACILITY NUMBER:
197606938
ADMINISTRATOR:AUGUSTINE KEHINDEFACILITY TYPE:
740
ADDRESS:43129 LEMONWOOD DRIVETELEPHONE:
(661) 943-8194
CITY:LANCASTERSTATE:CAZIP CODE:
93536
CAPACITY:6CENSUS: 4DATE:
07/07/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Augustine Kehinde - AdministratorTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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9
Staff yell at residents
Staff are not meeting residents laundry needs
Staff are not meeting residents bedding needs
Staff are not providing adequate food service to residents
Staff did not prevent a resident from entering another resident's room
Staff did not safeguard resident's personal belongings
Staff do not provide activities for residents
Staff are inappropriately punishing resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Evelin Rios and Licensing Program Manager (LPM) Mary Flores conducted an unannounced complaint visit at this facility for the above allegations. LPA was greeted and granted access by a staff member. The administrator, Augustine Kehinde met LPA and LPM shortly after. LPA explained the reason for the visit. An entrance interview was conducted.

The investigation consisted of the following:

LPA initiated a physical plant tour of the facility to ensure the health and safety of residents in care. While conducting the tour, from 9:10 a.m., to 10:40 a.m., LPA interviewed four (4) out of four (4) residents and two (2) staff. At approximately, 11:45 a.m., LPA and LPM interviewed the administrator. LPA obtained and reviewed copies of the facility's residents roster, personnel report (LIC 500), residents' admission agreements, residents', physician's reports, and Resident Personal Property and Valuables document.
(Continue to LIC9099-C) Page 1 of 4
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 31-AS-20260702115847
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: AUTUMN HILLS RESIDENTIAL HOME, INC.
FACILITY NUMBER: 197606938
VISIT DATE: 07/07/2026
NARRATIVE
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Interviews with residents revealed exit doors have not been blocked preventing residents from using the doors. Interviews with staff revealed staff do not block the exit doors at the facility to prevent residents from exiting. They have a sound device monitoring system that notifies them when an exit door is open. During the facility’s tour, LPA observed room #2(BR#2), which is a share room with two hospital beds, a curtain in the middle to provide privacy, a stack of storage space to the right of the bed closest to the exit. An exit door to the left of the bed and a tray table blocking the passageway to the exit door. There is about 3 feet of space between the beds and about 2 1/2 feet in between the bed closest to the exit doors and the wall passageway. And about 2 feet between the end of the beds and the wall where the closet is located. Even though the tray table can be moved it causes a hazard in case of an emergency by blocking the exit door. Therefore, this allegation is substantiated.
Based on LPA's observations, interviews which were conducted, and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Regarding allegation Staff do not keep the facility maintained. It is alleged there are hazards in the facility’s backyard due to lack of maintenance. Interviews with residents revealed the facility is in working condition. Interviews with staff revealed the administrator is in charge of any repairs at the home and does a review of the home at least twice a week. During the tour of the facility LPA observed, carpet ripped with a gap of about an inch from wall to wall in room #4(BR#4)’s doorway. Room #1(BR#1) had a dent in the wall where the bed is against it, and it is eye level to the resident in care, a screw was observed in the corner of the room. Bathroom #1(BT#1) has a crack with an opening in the wall under the towel rack the size an orange. The backyard has a cover pergola over the exit door from the family room into the backyard that was observed cracking probably from water damage, the ground floor has a crack the size of a grapefruit on the right side of the patio area, screen door was observed leaning against the wall over a bicycle, a landscape border was observed bended and down against the dirt in the garden area, a broken rake was observed laying in the grass area.
Based on LPAs observations, interviews which were conducted, and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Exit interview was conducted and a copy of this report, LIC9099D, and appeal rights was provided to administrator.
SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 31-AS-20260702115847
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: AUTUMN HILLS RESIDENTIAL HOME, INC.
FACILITY NUMBER: 197606938
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/08/2026
Section Cited
CCR
87307(a)(2)(A)
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Personal Accommodations and Services (a)... provide comfortable living accommodations... The following provisions shall apply: (2) Resident bedrooms shall... : (A)... allow for easy passage... This requirement is not met as evidenced by:
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The administrator will certify in writing a plan of how the room will be re arranged with the required furniture to ensure passageways and exit doors are not blocked and send the statement to the department by POC due date 07/08/2026.
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Based on observations the licensee did not ensure a exit door was not blocked by a tray table and furniture did not allow for easy passage around bedroom #2 which poses an immediate health, safety or personal rights risk to persons in care.
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Type B
07/17/2026
Section Cited
CCR
87303(a)
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Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:
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The administrator will repair issues to facility and send a picture of the repairs to the department by POC due date 07/17/2026.
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Based on observations the licensee did not ensure facility was free of wall holes/cracks, floor cracks and carpet damage and maintain the black yard organized which poses an potential health, safety or personal rights risk to persons in care.
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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: Mary G Flores
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026
LIC9099 (FAS) - (06/04)
Page: 7 of 7
Control Number 31-AS-20260702115847
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: AUTUMN HILLS RESIDENTIAL HOME, INC.
FACILITY NUMBER: 197606938
VISIT DATE: 07/07/2026
NARRATIVE
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Regarding the Allegation: Staff are not providing adequate food service to residents. It is alleged, that residents are only served hotdogs, rice and noodles. LPA’s interviews with two (2) staff members stated they follow a menu and residents have not complained about meals. One (1) staff member stated that they do serve hotdogs but will serve various balanced meals as well. LPA’s interviews with four (4) out of (4) residents denied the allegation, stating staff provide different meals consisting of protein, grains and vegetables. Interview with one (1) resident stated they request soft or liquified food and staff will follow their instructions. LPA’s review of residents’ Physician’s Reports did not indicate any residents have a prescribed special diet. LPA observed various food in the refrigerator and pantry.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Regarding the Allegation: Staff did not prevent a resident from entering another resident's room. It is alleged, that a resident goes into other residents rooms. LPA’s interviews with one (1) of (2) staff members stated there are two residents that enter another residents room. One of those residents was a previous roommate and will go into the room with permission. The other resident had entered the room after the resident residing in the room had offered them snacks and may enter again but is redirected. Interview with the administrator revealed, one (1) resident when they were first admitted to the facility was wandering at night and had entered another residents room but may have been sleepwalking or had entered the room by mistake. The resident was re-evaluated and with new physician orders has improved wandering behavior. LPA’s interviews with four (4) out of (4) residents reported no issues with residents entering their rooms.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

(Continue to LIC9099-C) Page 3 of 4

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 31-AS-20260702115847
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: AUTUMN HILLS RESIDENTIAL HOME, INC.
FACILITY NUMBER: 197606938
VISIT DATE: 07/07/2026
NARRATIVE
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Regarding allegation: Staff did not safeguard resident’s personal belongings. It is alleged a watch was stolen from a resident. Interviews conducted with residents revealed that none of their personal belongings have gone missing. Interviews conducted with staff revealed one resident had claimed to have lost their wallet. However, staff looked for the wallet and was found and no other residents reported anything missing. LPA reviewed Resident Personal and Property Values sheets for four (4) residents, each list their personal belongings such as clothing, glasses, and other items.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Regarding allegation: Staff do not provide activities for the residents. It is alleged there are no activities available for the residents and residents only watch TV. Interviews with residents revealed residents prefer to watch TV. Two (2) residents stated that there are volunteers who come to either play chess or provide entertainment. Residents also stated that they like taking walks. Interviews with staff revealed residents would rather watch TV than engage in activities. During facility’s tour LPA observed a set of domino and a board game that was stored in the closet and some magazines in the living room. Facility maintains a daily activity sheet that includes activities of daily living(ADLs), brisk walk, leg pedaling, tea time, free activities, drawing, games, reading, and karaoke.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Regarding allegation: Staff are inappropriately punishing residents. It is alleged a resident is being asked to stay in their room as a result for using the bathroom consistently. Interviews with residents revealed staff treat them with respect and have not been threatened or punished by the staff. Interviews with staff revealed that staff treat the residents with respect, they are aware not to threaten or punish the residents. Personal Rights training was provided on 4/21/2026 to the staff.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted. Copy of report provided to administrator. Page 4 of 4
SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 7