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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608821
Report Date: 10/12/2023
Date Signed: 10/12/2023 05:01:47 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., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/02/2023 and conducted by Evaluator Tihesha Smith
COMPLAINT CONTROL NUMBER: 31-AS-20231002154737
FACILITY NAME:WILLOUBEE RESIDENTIAL INC.FACILITY NUMBER:
197608821
ADMINISTRATOR:MARCUS WILLOUGHBYFACILITY TYPE:
735
ADDRESS:3559 EMERALD LANETELEPHONE:
(661) 941-9051
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:4CENSUS: 4DATE:
10/12/2023
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Jessica HernandezTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Staff is providing marijuana to resident in care.
INVESTIGATION FINDINGS:
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On 10/12/2023, Licensing Program Analysts (LPAs) Tihesha Smith and Lorena Casillas conducted an unannounced complaint visit to this facility to investigate the allegations above. LPAs were greeted by staff and disclosed the purpose of the visit. The administrator was contacted and arrived at approximately at 12:44 p.m.

Staff is providing marijuana to resident in care

It is alleged that Staff (S1) is providing marijuana to Resident #1 (R1). LPAs interviewed staff, residents, reviewed facility records, and requested copies of documents relevant to the investigation from approximately 10:00-3:10 pm. S1 was not present at the facility. Interviews with two (02) out of two (02) residents revealed they have not been given any marijuana by staff and have not witnessed any staff providing marijuana to residents in care. LPA interview with Resident #1 (R1) on 10/03/23 revealed that Staff #1 (S1) and
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
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 31-AS-20231002154737
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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: WILLOUBEE RESIDENTIAL INC.
FACILITY NUMBER: 197608821
VISIT DATE: 10/12/2023
NARRATIVE
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( Cont from 9099C)

all other staff does not buy or provide them marijuana. Interviews with three (3) staff present at facility revealed they have not provided marijuana to residents and have not witnessed other staff providing marijuana to residents in care.

Based on interviews, observation, and record review there is insufficient pertinent information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3