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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608821
Report Date: 06/20/2024
Date Signed: 06/20/2024 01:34:38 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:
06/20/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Jessica Herenandez/AdministratorTIME COMPLETED:
01:44 PM
ALLEGATION(S):
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Staff smokes marijuana on the premises of the facility
Staff threatened resident safety
INVESTIGATION FINDINGS:
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Licensing program Analyst (LPA) Tihesha Smith made an unannounced subsequent complaint visit to this facility at approximately 9:45 am. The administrator was at the facility. LPA Smith met with the administrator and disclosed the purpose of the visit.

Staff smokes marijuana on the premises of the facility
It was alleged that Staff smokes marijuana on the premises of the facility. To investigate the allegation, on 10/12/23, LPA Tihesha Smith and LPA Lorena Casillas LPAs interviewed staff, residents, reviewed facility records, and requested copies of documents relevant to the investigation from approximately 10:00-3:10 pm. During today's visit, LPA Smith interviewed staff and resident from 11:15-11:50 am. Interviews with two (2) of three (3) residents revealed staff smoke cigarettes in their car. Interviews with four (4) of four (4) revealed they do not smoke marijuana on the facility premises and have not witnessed any other staff smoking marijuana on the facility premises. Two (2) of two (2) staff also revealed staff does smoke cigarettes in designated smoking areas at facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
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 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: 06/20/2024
NARRATIVE
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(Cont. from 9099)

Staff threatened resident safety
It was alleged that staff threatened residents in care. In regard to the allegation, four (4) of four (4) staff revealed that staff has never threatened residents’ safety. One (1) of four (4) staff revealed R1 who has threatened their safety by attempting to get them fired due to staff reminding R1 not to smoke marijuana in their room or in the facility. Two (2) of three (3) residents revealed does not fear for their safety and/or staff has not threatened their safety.

Based on interviews, there is insufficient pertinent information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time



Exit interview conducted/copy of report given.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2