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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609060
Report Date: 10/05/2022
Date Signed: 10/06/2022 01:23:43 PM

Substantiated


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
10/04/2022 and conducted by Evaluator Melissa Ruiz
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20221004100310
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: 5DATE:
10/05/2022
UNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Ade Aruwajoye - staffTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility staff member was not wearing a mask.
INVESTIGATION FINDINGS:
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On 10/6/2022 Licensing Program Analyst (LPA) Melissa Ruiz arrived at the facility to conduct an unannounced complaint investigation. Upon arrival, LPA was greeted by staff (S1) and S1 was observed to not be wearing a mask. At 12:30 p.m., LPA conducted a tour of the facility to ensure no immediate health and safety issues were present. S1 contacted administrator and LPA discussed the purpose of the visit with administrator.
Allegation: Facility staff member was not wearing a mask.
It is alleged that on 9/28/22, a credible witness visited the facility and the facility Administrator, Sunday Olowosagba and was observed to not be wearing a mask. LPA interviewed the Administrator, to which he confirmed that sometime around September 2022, a random visit was made by a credible witness who observed facility staff were not wearing masks and not screened upon entry. Administrator admitted that a verbal conversation with the credible witness took place regarding these observations. Based on interview with administrator, this allegation is deemed Substantiated. Report was signed and delivered. Deficiencies were issued per CA code of Regulations Title 22 on LIC9099-D with this report. Appeal rights issued. Report signed and delivered. Exit interview conducted.
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: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 31-AS-20221004100310
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: 10/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/08/2022
Section Cited
CCR
87570(c)(1)(F)
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87470(c) Infection Control Requirements shall be developed by the licensee... (1) The Infection Control Plan shall include: (F) Staff shall demonstrate knowledge... appropriate to the job assigned and..
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Administrator agreed to provide in house training with all staff regarding Infection Control Requirements and COVID Protocol. A written statement signed by all staff regarding such training shall be emailed to LPA no later than 10/8/22.
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This requirement is not met as evidenced by:

Based on observation and an interview with the Administrator, Administrator did not ensure staff complied with the section cited above by not wearing masks which poses a potential Health and Safety and 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: 10/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
LIC9099 (FAS) - (06/04)
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