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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609804
Report Date: 10/15/2024
Date Signed: 10/15/2024 04:08:54 PM

Substantiated


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
10/11/2024 and conducted by Evaluator Huma Rahimi
COMPLAINT CONTROL NUMBER: 31-AS-20241011113308
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:
10/15/2024
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Moses Wakabi, AdministratorTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Staff are promoting unsafe behaviors with client in care
INVESTIGATION FINDINGS:
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At 11:45 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced initial complaint visit. LPA met with staff, Hariet Huweit, and Administrator was contacted via telephone. LPA explained the reason for the visit. Administrator arrived shortly after.

During course of the investigation, interviews and record review were made. At 11:50 AM, LPA requested client and staff roster. At 12:10 PM, LPA requested copies of pertinent information which include, but not limited to Physician’s Report, Admission Agreement, Appraisal Needs and Services Plan, etc., relevant to the investigation. At approximately 10:10 AM, LPA conducted a physical plant tour. Between 10:20 AM – 02:15 PM, LPA conducted an interview with the Administrator, two (2) staff, and three (3) out of four (4) clients who were available.
Continue on LIC 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
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 5
Control Number 31-AS-20241011113308
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: ALLIANCE ADULT RESIDENTIAL HOMES INC
FACILITY NUMBER: 197609804
VISIT DATE: 10/15/2024
NARRATIVE
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Staff are promoting unsafe behaviors with client in care:

It is alleged that the facility staff allow C1 to use a wet rag to their body instead of taking a shower which can cause the infection on C1’s skin. To investigate this allegation LPA conducted interview with the Administrator and was informed that occasionally when C1 refuses to take a shower they do offer him/her to use a wet towel instead. Interview with staff confirmed the information. In addition, interview with two (2) out of four (4) clients also revealed that they are allowed to use wet towels when they refuse to take a shower. Based on the interviews and information gathered, during todays visit, this allegation is Substantiated.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
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
10/11/2024 and conducted by Evaluator Huma Rahimi
COMPLAINT CONTROL NUMBER: 31-AS-20241011113308

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:
10/15/2024
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Moses Wakabi, AdministratorTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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9
Staff did not ensure client’s medical care needs were properly met
INVESTIGATION FINDINGS:
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At 11:45 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced initial complaint visit. LPA met with staff, Hariet Huweit, and Administrator was contacted via telephone. LPA explained the reason for the visit. Administrator arrived shortly after.

During course of the investigation, interviews and record review were made. At 11:50 AM, LPA requested client and staff roster. At 12:10 PM, LPA requested copies of pertinent information which include, but not limited to Physician’s Report, Admission Agreement, Appraisal Needs and Services Plan, etc., relevant to the investigation. At approximately 10:10 AM, LPA conducted a physical plant tour. Between 10:20 AM – 0215 PM, LPA conducted an interview with the Administrator, two (2) staff, and three (3) out of four (4) clients who were available.
Continue on LIC 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 31-AS-20241011113308
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: ALLIANCE ADULT RESIDENTIAL HOMES INC
FACILITY NUMBER: 197609804
VISIT DATE: 10/15/2024
NARRATIVE
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Staff did not ensure client’s medical care needs were properly met:

It is alleged that the facility staff did not properly meet C1’s medical care needs. To investigate this allegation LPA conducted an interview with credible witness who informed LPA that they observed rashes on C1 on 10/07/2024. It was brought up to the Administrator’s attention and C1 was seen by the Physician on 10/08/2024. LPA conducted an interview with the Administrator and two (2) staff who informed LPA that the facility staff were already aware of the rashes on C1 and made an appointment with the Physician to be seen. Furthermore, LPA was provided with the text messages and photos which indicated the date and time of the credible witness reporting to the Administrator. Lastly, two (2) out of four (4) clients interviews denied the above allegation and did not express any concerns regarding this. Therefore, it was determined that the facility did schedule the doctor’s appointment for C1 prior it was brought to their attention by the Day-Program. Based on the interviews and record review this allegation is deemed Unsubstantiated at this time.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 31-AS-20241011113308
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: ALLIANCE ADULT RESIDENTIAL HOMES INC
FACILITY NUMBER: 197609804
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/22/2024
Section Cited
CCR
80078(a)
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80078-Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the client's needs.
This requirement is not met as evidenced by:
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The Administrator is required to hold a training for all staff on the section cited and submit a log to LPA by POC due date.
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Based on interviews licensee did not comply with the section cited above by providing wet towels instead of showers to C1 that caused more rashes to C1 which poses/posed a potential health and safety risk to clients in care.
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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: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5