197609804-9-23-2021-31-AS-CHAS-CC43K9-20220228171847

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609804
Report Date: 09/23/2021
Date Signed: 09/23/2021 02:27:49 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
09/15/2021 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20210915143655

FACILITY NAME:	ALLIANCE ADULT RESIDENTIAL HOMES INC		FACILITY NUMBER:	197609804
ADMINISTRATOR:	WAKABI, MOSES D		FACILITY TYPE:	735
ADDRESS:	7821 HESPERIA AVENUE		TELEPHONE:	(747) 254-4154
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	4	CENSUS: 3	DATE:	09/23/2021
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Moses Wakabi		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Staff member did not seek timely medical care for client
Facility has bed bugs

INVESTIGATION FINDINGS:

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Licensing Program Analyst(s) Nicholas Reed and Wendell Smith conducted an unannounced complaint visit to investigate the allegations above. LPA met with facility staff and explained the reason for this visit. Administrator was contacted and joined the visit at approximately 9:45 am.
From approximately 9am-9:15am a physical plant tour was conducted to ensure no health and safety issues were present. No health and safety issues were observed during the physical plant tour.
Staff member did not seek timely medical care for client
It is alleged that client #1 (C1) needed immediate care and the facility failed to provide that. Interviews were conducted with C1, administrator, and facility staff from approximately 9:20am through 10:20am regarding the allegation. From 10:20-10:45am C1's facility file was reviewed and copies of pertinent information was obtained by LPA's. Information obtained from interviews revealed that C1 awoke on the morning of 9/12/21 and had a rash on their body and called the administrator about receiving medical attention. Administrator stated staff could take C1 to urgent care but C1 wanted the administrator specifically to take them. A few hours later C1 was taken to receive medical attention by the administrator.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20210915143655

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
	VISIT DATE: 09/23/2021

NARRATIVE

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C1 initially believed that they had bed bug bites. LPA's obtained copies of C1's physician visit on 9/12/21. Based on the information obtained through interviews and record review this allegation is deemed Unsubstantiated at this time. When C1 contacted the administrator regarding wanting to be taken to urgent care for a rash, C1 was fine waiting for the administrator to take them instead of other facility staff.

Facility bed bugs
It is alleged that C1 believed they had bed bug bites on their body when they awoke on 9/12/21. LPA's conducted interviews with C1, facility staff, and the administrator. LPA's obtained copies of C1's physician visit on 9/12/21. Information obtained from interviews and a review of C1' physician visit indicate that C1 did not have bed bug bites but had mosquito bites. After C1 got back from their physician sheets, their bed linen was changed and their bed mattress was sprayed with bug spray per client's request. Based on the information obtained this allegation is deemed Unsubstantiated at this time.
Exit Interview conducted.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2021

LIC9099 (FAS) - (06/04)

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