<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609337
Report Date: 04/05/2022
Date Signed: 04/05/2022 11:34:55 AM

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
12/30/2021 and conducted by Evaluator Shira Stamps
COMPLAINT CONTROL NUMBER: 31-AS-20211230143629
FACILITY NAME:MOLOCK RESIDENTIAL IIFACILITY NUMBER:
197609337
ADMINISTRATOR:MOLOCK, JONATHANFACILITY TYPE:
735
ADDRESS:43140 E 33RD STREETTELEPHONE:
(661) 674-8592
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:4CENSUS: 2DATE:
04/05/2022
UNANNOUNCEDTIME BEGAN:
10:42 AM
MET WITH:Monica Vartanian, AdministratorTIME COMPLETED:
11:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident's are not being treated equally

Staff are not providing resident with transportation
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At 10:43 am, Licensing Program Analyst (LPA) Shira Stamps conducted a subsequent complaint visit regarding the complaint allegations listed above. LPA called the Administrator at 10:47am, and the Administrator stated she was on her way to the facility. At 11:21 am the Administrator arrived, and LPA explained the purpose of this visit. Entrance interview conducted

Allegation: Residents are not being treated equally.

During the initial complaint visit, LPA interviewed two (2) out of four (4) clients. One(1) out of two (2) clients that were interviewed indicated they felt they were treated equally. LPA reviewed the Individual program plans (IPPs) for all four (4) clients, and found staff are following the IPP accordingly for each client. LPA found that each IPP is different and is made for each specific client. Based on document review, the allegation, “residents are not being treated equally,” is deemed unsubstantiated.
CONTINUED...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2022
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-20211230143629
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: MOLOCK RESIDENTIAL II
FACILITY NUMBER: 197609337
VISIT DATE: 04/05/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff are not providing resident with transportation.

Based on interviews with three (3) out of three (3) staff members it was indicated that clients are provided transportation to medical appointments, the grocery store, and community outings on the weekend. LPA reviewed the IPP’s for four (4) out of four (4) clients and found that the staff is providing transportation according to the IPP guidelines. Therefore, the allegation, “staff are not providing resident with transportation,” is deemed unsubstantiated.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2