197609804-12-12-2024-31-AS-NGID-DD7NRC-20250123094117

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609804
Report Date: 12/12/2024
Date Signed: 12/12/2024 02:30:09 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
12/09/2024 and conducted by Evaluator Huma Rahimi

COMPLAINT CONTROL NUMBER: 31-AS-20241209145821

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: 4	DATE:	12/12/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Moses Wakabi, Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Resident consumed stolen prescription drugs due to lack of care and supervision from staff

INVESTIGATION FINDINGS:

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At 10:50 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced initial complaint visit. LPA met with staff, Patrick Mugenyi, and Administrator was contacted via telephone. Administrator arrived shortly after. LPA explained the reason for the visit. The Administrator designated Patrick Mugenyi, the staff to sign and receive today's complaint report.

During course of the investigation, interviews and record review were made. At 10:55 AM, LPA requested client and staff roster. At 11:00 AM, 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 11:05 AM, LPA conducted a physical plant tour. Between 11:30 AM – 2:20 PM, LPA conducted an interview with the Administrator, three (3) staff, and two (2) 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: 12/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024

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-20241209145821

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: 12/12/2024

NARRATIVE

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Resident consumed stolen prescription drugs due to lack of care and supervision from staff:
It is alleged that Client #1 (C1) stole and consumed sleeping pills from CVS pharmacy due to lack of care and supervision. To investigate this allegation LPA conducted an interview with the Administrator and two (2) staff who informed LPA that on 11/30/2024, C1 left the facility and went to a Dollar Store; however, two staff (S1 & S2) followed C1 within a close distance and redirected C1 back to the facility. LPA reviewed an incident report which was submitted to Regional Office on 12/03/2024, that also confirmed the information provided. Interview with C1 during today's collateral visit at 9:40 AM, at The Adult Skills Center (TASC), Day-Program revealed that on 11/30/2024, C1 went to CVS Pharmacy and took half bottle of sleeping pills without the store employees knowledge. At 10:20 AM, LPA conducted a collateral visit to CVS and interviewed the Store Manager (SM) who denied ever seeing or witnessing C1 taking any medication from the store. SM also informed LPA that the store does not have any stolen or damaged sleeping pills bottles inventory for the past (30) days. Additionally, the SM viewed the surveillance footage and confirmed to LPA that there was no one with such an incident recorded for 11/30/2024. Lastly, interview with two (2) out of four (4) clients also expressed no concerns regarding the above allegation. Based on the interviews and record review, the allegation is deemed unsubstantiated at this time.

No deficiencies cited during today's visit.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024

LIC9099 (FAS) - (06/04)

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