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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609370
Report Date: 08/09/2022
Date Signed: 08/09/2022 03:09:54 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
03/04/2021 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20210304115339
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: 4DATE:
08/09/2022
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Yudaya NamagembeTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff did not provide adequate supervision
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuesday Cabiness met with staff Yudaya Namagembe and informed her the reason of the visit. Administrator Moses Wakabi was contacted, and also informed him the purpose of the visit. The following was determined:

Concerns were expressed that staff did not provide adequate supervision. On 03/12/2021, 03/15/2021, and 06/22/2021, from various times, ranging from 9am to 3pm, LPA conducted interviews and reviewed documentation pertaining to the complaint. It was reported to LPA a friend of client # 1 (C1) visited the facility, unannounced after midnight. Staff discovered the visitor in the back yard, trying to enter the facility. The visitor was instructed to leave by C1 and staff. Further information revealed, there was a second incident where C1 allowed the visitor to enter C1’s room, through the back door, without staff acknowledgement. Although staff was not aware of the visitor, it was an isolated incident, and C1 acknowledged that C1 made a mistake by allowing the visitor to be at the facility unannounced. C1 was given instructions regarding visiting, especially during the time of the pandemic. C1 promised staff, that C1 would not allow it to happen again.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022
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-20210304115339
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: 08/09/2022
NARRATIVE
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It was also reported to LPA, that the facility installed an alarm on C1’s back door, so that staff would be alerted when the door was opened during all times. There had been no further incidents since the installation of the alarm. Therefore, based on interviews and other documentation, the allegation is UNSUBSTANTIATED at this time.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2