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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609727
Report Date: 12/17/2024
Date Signed: 12/17/2024 03:03:09 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
12/10/2024 and conducted by Evaluator Lorena Casillas
COMPLAINT CONTROL NUMBER: 31-AS-20241210160619
FACILITY NAME:WE R ONE FAMILY HOME, INC.FACILITY NUMBER:
197609727
ADMINISTRATOR:TYRONE QUALSFACILITY TYPE:
735
ADDRESS:723 E. OLDFIELD STTELEPHONE:
(562) 644-7260
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:4CENSUS: 3DATE:
12/17/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Doretha WilhiteTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff forged residents' signature.
INVESTIGATION FINDINGS:
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On 12/16/24 at 11:30 am Licensing Program Analyst (LPA) Lorena Casillas conducted an unannounced complaint visit to investigate the above stated allegation. LPA was greeted by staff and was granted access. Administrator, Tyrone Quals, called LPA and LPA explained the reason for the visit, Administrator would not be able to meet with LPA and assigned House Manger Doretha Wilhite to sign the report.

At 12:00 pm LPA Casillas conducted a physical plant tour. During the investigation, interviews and record reviews were conducted from 12:30 am to 2:30 pm. LPA requested copies of client roster and updated LIC 500 and surety bond. LPA requested copies of pertinent information relevant to the investigation including but not limited to appraisals, client records, and any information pertaining to clients and care.

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
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-20241210160619
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: WE R ONE FAMILY HOME, INC.
FACILITY NUMBER: 197609727
VISIT DATE: 12/17/2024
NARRATIVE
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Allegation: Staff forged residents’ signature.

It Is alleged that staff forged Client #1 (C1) signature on a form submitted to C1’s hospital. Regarding this allegation, it is reported that facility staff forged C1’s signature on consent forms submitted to the hospital and other facility forms, to obtain C1’s medical insurance card, Identification card, and social security card. C1 is not conserved and states that they did not authorize any signatures for any documents. LPA interviewed the Administrator over the phone, and they state that no signatures for any clients have been forged. Administrator states that if clients do not wish to sign documents, then they do not need to sign anything. Furthermore, Administrator stated that staff explain what the consent forms are for and if clients chose not to sign, then the forms don’t get signed and a notation is made that client refused to sign. LPA interviewed Staff #1 (S1) and it was stated that S1 has no knowledge of any documents being forged, nor would staff do that since clients can refuse to sign documents and staff is allowed to notate the refusal. LPA interviewed Staff #2 (S2) and S2 corroborated what Administrator and S1 stated, S2 confirms that when a client refuses to sign documents the staff just notate the document as “refused to sign”. LPA interviewed C1 and C1 stated that they do not have proof that documents were forged, C1 states that it’s a suspicion but can’t prove it. C1 stated that they do not understand how facility has C1’s documents and suspects that the documents were obtained illegally. LPA explained to C1 that some documents are provided by North Los Angeles Regional Center (NLARC) for all clients as part of their client folders. C1 stated that they were not aware of this. LPA interviewed Client #2 (C2) and Client #3 (C3) and both stated that they have voluntarily singed any documents given to them after staff have explained what the documents are for and that they have not witnessed any documents being forged. During LPA record review LPA discovered that C1 has signed numerous documents to include consent for medical treatment, consent of release of information and other forms to compare C1’s signature, there was also no record of a social security card or medical insurance card, C1’s identification card was present and C1 confirmed that they provided it. LPA spoke to C1 and showed C1 said documents to confirm if these were signed by C1. C1 confirmed that they did in fact sign these documents and that they were not forged. Therefore, based on interviews, documents and observations, this allegation is deemed Unsubstantiated.

No citation issued. Exit interview conducted. Copy of report provided to Administrator and House Manager.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC9099 (FAS) - (06/04)
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