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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609370
Report Date: 08/28/2021
Date Signed: 08/28/2021 02:26:01 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
03/24/2021 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20210324143628
FACILITY NAME:AGAPE RESIDENTIAL HOMEFACILITY NUMBER:
197609370
ADMINISTRATOR:WAKABI, MOSES DFACILITY TYPE:
735
ADDRESS:8800 JUMILLA AVETELEPHONE:
(747) 224-0635
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY:4CENSUS: 3DATE:
08/28/2021
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Namagembe YudayaTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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1. Staff member used inappropriate language toward resident
2. Staff member inappropriately handled resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuesday Cabiness conducted an unannounded initial visit, and met with direct care staff Namagembe Yudaya, who was informed the reason of the visit. Staff contacted Administrator Moses Wakabi, who was also informed the reason of the visit and was given the final findings of the allegations mentioned above:

Allegation # 1: Allegation # 1: Staff member used inappropriate language toward resident. On April 05, 2021, and June 22, 2021, LPA conducting interviews with staff, clients, and other parties involved with the complaint, from various times, ranging from 12pm to 4pm. Through those interviews, it was reported, there was an incident between clients in the backyard, and client # 1 (C1) verbally assaulted and punched C2, causing C2 to fall. C2 revealed that staff attempted to de-escalate C1, but to no avail, and C1 began to verbally assault staff and C2. It was also reported by C2, C1 used inappropriate language and profanity towards staff and C2
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2021
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 2
Control Number 31-AS-20210324143628
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: AGAPE RESIDENTIAL HOME
FACILITY NUMBER: 197609370
VISIT DATE: 08/28/2021
NARRATIVE
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Staff did not use inappropriate language to either clients and attempted to intervene and calm C1 down. Staff also denied using inappropriate language to clients. LPA was not successful in obtaining further information pertaining to the allegation from C1. Therefore, based on interviews and other information reviewed, there is insufficient evidence to conclude “Staff member used inappropriate language toward resident”, and the allegation is UNSUBSTANTIATED at this time.

Allegation # 2: Staff members inappropriately handled resident. On April 05, 2021, and June 22, 2021, LPA conducting interviews with staff, clients, and other parties involved with the complaint, from various times, ranging from 12pm to 4pm. Through those interviews, it was reported, there was an incident between clients in the backyard, and client # 1 (C1) verbally assaulted and punched C2, causing C2 to fall. C2 revealed that staff attempted to de-escalate C1, but to no avail, and C1 began to verbally assault staff and C2. Although it was alleged staff used inappropriate language and "got in the face" of C1, it was reported by C1, "staff did not touch C1". LPA was not successful in obtaining further information pertaining to the allegation from C1. Therefore, based on interviews and information reviewed, there is insufficient evidence to conclude, "Staff members inappropriately handled resident", and the allegation is UNSUBSTANTIATED at this time.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2