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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609370
Report Date: 01/13/2025
Date Signed: 01/13/2025 12:47:13 PM

Document Has Been Signed on 01/13/2025 12:47 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:AGAPE RESIDENTIAL HOMEFACILITY NUMBER:
197609370
ADMINISTRATOR/
DIRECTOR:		DAVID KAWOOYAFACILITY TYPE:
735
ADDRESS:8800 JUMILLA AVETELEPHONE:
(747) 224-0635
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY: 4CENSUS: 3DATE:
01/13/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Innocent Kateregga & David KawooyaTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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Licensing Program Analysts (LPAs) Tuesday Cabiness and Angelica Segovia conducted an unannounced case management visit, and met with staff Innocenct Kateregga , who was informed the reason of the visit. The Administrator David Kawooya was contacted who told LPAs, he was on his way to the facility. Administrator arrived at 12pm, and was informed the reason of the visit, which is to deliver enhanced civil penalties (ECP). During the visit, the Administrator contacted Licensee Farouk Kabunga who was also informed and explained the reason of the visit via telephone. The following information was provided to the Administrator & Licensee:

On December 30, 2020, the Woodland Hills South Adult and Senior Care Regional Office received a complaint that a client (C1) sustained injuries while in care and staff (S1) threatened C1. The complaint was referred to the Investigations Branch (IB) and accepted as a full investigation.

In addition, on March 15, 2021, the RO received a second complaint that S1 sexually and physically abused client in care. The complaint was referred to the Investigations Branch (IB) and accepted as a full investigation.

On July 29, 2021, the Department concluded complaint investigations which alleged that staff physically abused C1 while in care.

The allegation was substantiated, and the Licensee was cited under California Code of Regulations (CCR), Title 22, Division 6, Section 80072 (a)(3) Personal Rights.

The investigations revealed that on December 14, 2020, S1 punched and smashed C1’s head on the kitchen counter; threw C1 on the ground and kicked C1. This resulted in C1 sustaining a bump on C1's head, a laceration on the forehead, a swollen wrist, scrapes on the left arm and bruising. S1 threatened C1 with physical violence if C1 reported the abuse to anyone....

Cont'd to LIC809C -page 1

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE: DATE: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: AGAPE RESIDENTIAL HOME
FACILITY NUMBER: 197609370
VISIT DATE: 01/13/2025
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C1 was also directed by S1 to report that the physical injuries sustained on or about December 14, 2020, came from C1 falling in the closet rather than being caused by S1. The Los Angeles Police Department completed a battery report to open an investigation into the physical abuse allegation of C1. At the time of the visit on July 29, 2021, an immediate civil penalty of $500 was issued. The licensee was informed that an additional civil penalty may be assessed under Health and Safety §1548(f).

The Department has concluded an analysis and has determined that a civil penalty is warranted for physical abuse. The Welfare and Institutions Code Section 15610.63 for physical abuse means any of the following: (a) Assault, as defined in Section 240 of the Penal Code. This is evidenced by S1 physically abusing C1 on December 14, 2020, resulting in multiple injuries.



Today, 01/13/2025, the Department will be issuing a civil penalty per Health and Safety Code § 1548 (f)(1)(A) for a violation that the Department constitutes as physical abuse in the amount of $10,000. However, since an immediate civil penalty of $500 was previously issued on July 29, 2021, the amount of the civil penalty issued today is $9,500.

On March 15, 2021, the Woodland Hills South Adult & Senior Care Regional received a complaint that staff (S1) sexually and physically abused a client (C1) in care. The complaint was referred to the Investigations Branch (IB) and accepted as a full investigation.

On July 29, 2021, the Department concluded a complaint investigation which alleged that S1 sexually abused C1 while in care. The allegation was substantiated, and the Licensee was cited under California Code of Regulations (CCR), Title 22, Division 6, Section 80072 (a)(3) Personal Rights.

The investigation revealed that C1 disclosed that S1 would enter C1’s bedroom on an ongoing basis, close the door, sleep in the bed with C1 and penetrate C1’s rectum with S1’s private parts. C1 was found to have rectal bleeding. C1 reported to the investigator that this occurred multiple times. Another client (C2) overheard C1 crying and heard unknown sounds coming from C1’s room when S1 was in the room with C1. This was reported in 2021 to the Los Angeles Police Department, who investigated the complaint of sodomy incidents.

At the time of the visit on July 29, 2021, an immediate civil penalty of $500 was issued. The licensee was informed that an additional civil penalty may be assessed under Health and Safety §1548(f)..Cont'd from LIC809 - page 2

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025
LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: AGAPE RESIDENTIAL HOME
FACILITY NUMBER: 197609370
VISIT DATE: 01/13/2025
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The Department has concluded an analysis and has determined that a civil penalty is warranted for sexual assault. The Welfare and Institutions Code Section 15610.63 (e) for sexual assault means any of the following: (1) Sexual battery, as defined in section 243.4 of the Penal Code, and (2) Rape, as defined in Section 261 of the Penal Code, or former Section 262 of the Penal Code. This is evidenced by S1 sexually abusing C1 on multiple occasions at the facility by sodomizing C1.

Today, 01/13/2025, the Department is issuing a civil penalty per Health and Safety Code § 1548 (f)(1)(A) in the amount of $10,000 for a violation that the Department has resulted in sexual assault against C1. However, since an immediate civil penalty of $500 was previously issued on July 29, 2021, the amount of the civil penalty issued today is $9,500.

Both copies of the LIC 421D was given to Administrator David Kawooya and originals were signed. Administrator will forward the signed copies to Licensee.

Exit interview conducted. A copy of the report issued. Appeal Rights provided. Administrator David Kawooya, and signature on this report acknowledges receipt of the Appeal Rights, found on page two of LIC 421D.

Page 3 and final report.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025
LIC809 (FAS) - (06/04)
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