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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 03:07:13 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
08/18/2021 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20210818123800
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:
02:45 PM
MET WITH:Yudaya NamagembeTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff are mismanaging client's medication
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 the purpose of the visit. The following was determined:

Concerns were expressed that staff were mismanaging client's medication. On 08/26/2021, and 10/25/2021, from various times, from 10am to 2pm, LPA conducted interviews and obtained other documentation pertaining to the complaint. It was reported to LPA, that client #1 (C1) was newly admitted to the facility was having transitioning issues in the beginning of C1's stay. According to the complainant, C1 would make various loud noises and caused a disturbance. It was alleged that C1 was not given provided proper medication and the facility was mismanaging C1's medication. According to the interviews conducted, it was reported to LPA that initially C1 did not have a psychiatrist, and was in the process of assigning one to C1. It was also revealed that C1's medication was being reviewed and would possibly change. The facility was provided additional assistance for C1 to better transition to C1's new placement. Although C1 was having behavior issues
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-20210818123800
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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in the beginning, it was not due to medication issues. Therefore, based on information obtained and interviews, 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