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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607799
Report Date: 02/03/2022
Date Signed: 02/03/2022 02:31:34 PM

Unsubstantiated


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
03/04/2021 and conducted by Evaluator Zabel Chochian
COMPLAINT CONTROL NUMBER: 29-AS-20210304153612
FACILITY NAME:SAILS SIMIFACILITY NUMBER:
197607799
ADMINISTRATOR:AYOBAMI TEMILOLUWAFACILITY TYPE:
735
ADDRESS:3311 TAPO CANYON RDTELEPHONE:
(818) 224-7222
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY:4CENSUS: 3DATE:
02/03/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Marchelino RoosTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Client sustained bruising while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Zabel Chochian conducted an unannounced subsequent complaint visit to deliver final investigation finding regarding above allegations. During today’s visit LPA Chochian met with staff and explained reason for visit. Staff contacted new Administrator Marchelino Roos who arrived shortly after. Reason for visit was explained to Mr. Roos. Following is a summary of the investigation finding:

On 03/04/2021, the Department received a complaint regarding an allegation that a “Client sustained bruising while in care”. Information received that Client #1 (C1) claimed that C1 had bruising on C1's arm caused by Sails staff.
On 03/15/2021, LPA Chochian conducted the initial complaint visit. Due to the situation surrounding the Corona Virus Disease 2019 (COVID-19), and to implement mitigation measures, the initial complaint investigation was conducted telephonically with Administrator Ayobami Temiloluwa between the hours from 1:30 p.m. to 2:45 p.m. Administrator explained that an incident happened back on 2/5/2021 with C1 where C1 got very aggressive with staff and other clients. Administrator denied any physical contact with C1 on 2/5/2021. (cont. to LIC9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022
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 2
Control Number 29-AS-20210304153612
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: SAILS SIMI
FACILITY NUMBER: 197607799
VISIT DATE: 02/03/2022
NARRATIVE
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 Administrator stated that C1 showed the bruise on back of arm approximately two (2) days after the incident and when asked how it happened C1 did not know. A police report was not filed due to the criteria/assessment of the situation and inconsistent statements by C1.

LPA conducted interview with Tri-Counties Regional Center (TCRC) on 03/17/2021 at approximately 11:30a.m.; interview with facility staff on 06/03/2021 at approximately 10:15a.m. to 11:30a.m. Other potential witness interviewed on 06/03/2021 denied having any knowledge of the incident.

During the course of investigation, C1 was unwilling to provide any specific details of the 02/05/2021 incident. C1 denied recalling any detail about the allegation. According to TCRC C1 has a history of aggression towards facility staff, fabricating stories and noncompliance issues with the administrator. C1 refused to speak about the allegation and provided no significant detail of what was reported.

Based on the above information, there is not sufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. Exit interview conducted. Copy of report provided.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2