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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609060
Report Date: 10/14/2021
Date Signed: 10/14/2021 11:47:58 AM



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
10/07/2021 and conducted by Evaluator Melissa Ruiz
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20211007135308
FACILITY NAME:TREASURE HERITAGEFACILITY NUMBER:
197609060
ADMINISTRATOR:OLOWOSAGBA, SUNDAYFACILITY TYPE:
740
ADDRESS:2049 KALLIOPE AVENUETELEPHONE:
(661) 941-2258
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:6CENSUS: DATE:
10/14/2021
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Adesuyi AruwajoyeTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Licensee did not ensure that hazardous materials were inaccessible to residents.
INVESTIGATION FINDINGS:
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At 10:07 am, Licensing Program Analysts Melissa Ruiz and Joscelyn Martinez arrived at the facility mentioned above to conduct an unannounced complaint visit. Upon entry, LPAs were greeted by staff member, Adesuyi Aruwajoye. The Administrator, Sunday Olowosagba was not available at this time, therefore staff member Adesuyi was designated to sign this report. The purpose of this visit was explained to the Administrator telephonically. It is alleged that Licensee did not ensure that hazardous materials were inaccessible to residents. LPAs conducted a tour of the facility. Upon touring the facility, at 10:24 am, a cleaning chemical was observed to be accessible to residents in one of the bathrooms. LPAs also conducted interview with the Administrator at 10:50 am.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa RuizTELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
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 4
Control Number 31-AS-20211007135308
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: TREASURE HERITAGE
FACILITY NUMBER: 197609060
VISIT DATE: 10/14/2021
NARRATIVE
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The Administrator did state that he is aware that cleaning solutions have been left accessible to residents in the past. LPAs also interviewed staff member Adesuyi, who stated cleaning solutions have been left accessible to residents.

Based upon LPAs witnessing a cleaning chemical accessible, and interviews conducted, this allegation is substantiated at this time.

Deficiencies and Civil penalties were issued per CA code of Regulations Title 22 or Health and Safety Code. See 809D's included with this report. Appeal rights issued.

Exit interview conducted.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa RuizTELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 31-AS-20211007135308
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: TREASURE HERITAGE
FACILITY NUMBER: 197609060
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/16/2021
Section Cited
CCR
87309(a)
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 87309(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by:
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Administrator will conduct in-house training with all staff to keep cleaning solutions and chemicals inaccesible to residents and proof of training will be sent to LPA by due date.
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 Based on observation, the licensee did not comply with the section cited above. Cleaning agents and chemicals were found to be accessible to residents. This poses an immediate 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: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa RuizTELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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
10/07/2021 and conducted by Evaluator Melissa Ruiz
COMPLAINT CONTROL NUMBER: 31-AS-20211007135308

FACILITY NAME:TREASURE HERITAGEFACILITY NUMBER:
197609060
ADMINISTRATOR:OLOWOSAGBA, SUNDAYFACILITY TYPE:
740
ADDRESS:2049 KALLIOPE AVENUETELEPHONE:
(661) 941-2258
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:6CENSUS: DATE:
10/14/2021
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Adesuyi AruwajoyeTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Licensee did not ensure that medications were inaccessible to residents
INVESTIGATION FINDINGS:
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Allegation: Licensee did not ensure that hazardous materials were inaccessible to residents.

At 10:15 am, LPAs Melissa Ruiz and Joscelyn Martinez conducted a physical plant tour of the facility. LPAs toured the kitchen and observed the medication cabinet to be locked. No other medication was seen accessible to residents. LPAs interviewed the Administrator and staff and they stated medications are always kept locked and inaccessible to residents. Based on LPAs witnessing medications to be locked and interviews conducted, this allegation is unsubstantiated at this time. No citation issued.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa RuizTELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4