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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609804
Report Date: 08/26/2021
Date Signed: 08/26/2021 01:23:30 PM

Substantiated


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
08/16/2021 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20210816102454
FACILITY NAME:ALLIANCE ADULT RESIDENTIAL HOMES INCFACILITY NUMBER:
197609804
ADMINISTRATOR:WAKABI, MOSES DFACILITY TYPE:
735
ADDRESS:7821 HESPERIA AVENUETELEPHONE:
(747) 254-4154
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:4CENSUS: 4DATE:
08/26/2021
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Moses Wakabi, DirectorTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Facility staff do not prevent resident from smoking inside the facility.
INVESTIGATION FINDINGS:
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Allegation: Facility staff do not prevent resident from smoking inside the facility.
At 9:15am Licensing Program Analysts (LPAs) Angela Panushkina and Melissa Ruiz made an unannounced site visit for the purpose of conducting a complaint investigation. The facility was toured, and census was taken. LPAs requested and reviewed client #1 through #4 facility files to ensure that the facility is maintaining a separate, complete and current record of clients and that the files are centrally stored.
LPAs interviewed the Administrator at 9:35am. The Administrator confirmed that there is a client who uses marijuana, but only in designated, outdoor area. The Administrator informed the LPAs that C1 keeps marijuana in his possession will not give to the staff for safe keeping. LPA team also interviewed all four (4) clients. LPA team obtained C1’s Physician Report and the report had no medical marijuana prescription.
LPAs reviewed the facility plan of operation which clearly states that smoking is not allowed on the premises. LPA could smell the marijuana in the living room and dining area which were close to the C1s room. The allegation that the facility has allowed this resident to continue to possess and consume marijuana in the home is Substantiated.
An exit interview conducted, appeal rights explained and copy of this report given to Moses Wakabi.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
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-20210816102454
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: ALLIANCE ADULT RESIDENTIAL HOMES INC
FACILITY NUMBER: 197609804
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/02/2021
Section Cited
CCR
80072(a)(1)(3)
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(a) each client shall have personal rights which include, but are not limited to, the following:
(1)To be accorded dignity in his/her personal relationships with staff and other persons.
(3)To be free from corporal or unusual punishment...

This requirement is not met as evidenced by:
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The Administrator shall implement a system between the client and the facility for client's marijuana use and implement proper cleaning procedures of client's marijuana mechanisms in a designated area outside or in the kitchen sink. Written documentation of said system shall be reviewed and signed by Administrator,
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Facility staff do not prevent resident from smoking inside the facility
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staff and client. A copy shall be provided to LPA.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2