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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609322
Report Date: 06/05/2024
Date Signed: 06/05/2024 01:59:45 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
05/30/2024 and conducted by Evaluator Lorena Casillas
COMPLAINT CONTROL NUMBER: 31-AS-20240530152840
FACILITY NAME:WILLOUBEE RESIDENTIAL IIFACILITY NUMBER:
197609322
ADMINISTRATOR:WILLOUGHBY, MARCUS AFACILITY TYPE:
735
ADDRESS:3123 EMERALD LNTELEPHONE:
(661) 992-7699
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:4CENSUS: 4DATE:
06/05/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Jessica HernandezTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff refused to pick up a sick client from their day program.
INVESTIGATION FINDINGS:
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On 06/5/24 at 09:45 am Licensing Program Analyst (LPA), Lorena Casillas conducted an unannounced complaint visit to investigate the above stated allegation. LPA met with Administrator Jessica Hernandez and explained the reason for the visit.

At 9:45 AM LPA Casillas conducted a physical plant tour. During the investigation, interviews and record reviews were conducted. LPA requested copies of resident roster, LIC 500, bond and Administrator Certificate. LPA requested copies of pertinent information relevant to the investigation including but not limited to appraisals, physicians’ reports, and any information pertaining to residents and care.

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
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-20240530152840
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: WILLOUBEE RESIDENTIAL II
FACILITY NUMBER: 197609322
VISIT DATE: 06/05/2024
NARRATIVE
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Allegation #1 Staff refused to pick up a sick client from their day program.

It is alleged that staff refused to pick up a sick client from their day program. Regarding this allegation it was reported that on 5/23/24 Desert Haven Enterprises (DHE) staff made multiple attempts to contact facility staff and Administrator to have Client #1 (C1) picked up as they were not feeling well. It is alleged that multiple attempts were made however the facility staff was not answering the calls, therefore DHE staff deemed that C1 needed immediate medical attention and proceeded to call 911. LPA interviewed Staff #1 (S1) and it was revealed that when C1 texted S1 at 12:02pm, S1 immediately went to pick up C1 arriving at DHE at 12:15 pm. S1 was able to provide LPA with text messages to corroborate that they did in fact go to DHE to pick up C1, however C1 was at a different off site work site and S1 was told that C1’s grandmother would be taking them to Kaiser. LPA interviewed Administrator and it was revealed that calls made to Administrator were not ignored, a voicemail message was left, and the call was returned right away, Administrator was able to speak to DHE staff to advise that facility staff was already at DHE to pick up C1. Administrator was able to show LPA that a group text was initiated to coordinate the immediate pick up of C1. Facility staff was directed to pick up C1, however C1’s grandmother was also contacted by DHE and was at DHE at the same time as facility staff. Furthermore, interviews with staff revealed that there have not been any incidents where staff have abandoned clients. LPA conducted a collateral visit to DHE to interview C1 and it was revealed by C1 that S1 was at the main DHE office to pick up C1 however C1 was at a different location. C1 states that facility staff did not refuse to pick them up but that grandmother picked them up and took them to Kaiser instead. Therefore, due to interviews, record reviews and observations this allegation is deemed Unsubstantiated at this time.

No citation issued. Exit interview conducted and a copy of this report was given to the Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2