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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609804
Report Date: 04/10/2025
Date Signed: 04/10/2025 03:45:45 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
03/06/2025 and conducted by Evaluator Huma Rahimi
COMPLAINT CONTROL NUMBER: 31-AS-20250306093032
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: 3DATE:
04/10/2025
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Moses Wakabi, AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility does not employ required staff for the residents in care.
INVESTIGATION FINDINGS:
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At 9:30 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced subsequent complaint visit. LPA met with staff Frank Sebwato and the Administrator Moses Wakabi was contacted via telephone. The Administrator arrived shortly after and LPA explained the reason for the visit.

An initial visit was conducted on 03/11/2025. At 9:20 AM, LPA requested client and staff roster. At 9:25 AM, LPA requested copies of pertinent information which include, but not limited to Physician’s Report, Admission Agreement, Appraisal Needs and Services Plan, and etc., relevant to the investigation. At approximately 9:30 AM, LPA conducted a physical plant tour. Between 9:40 AM – 10:45 AM, LPA conducted an interview with the Administrator, four (4) staff, and one (1) out of four (4) clients who were available. Additional clients’ interviews were conducted on 04/07/2025, 04/08/2025, and 04/10/2025.


Continue on LIC 9099
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
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 3
Control Number 31-AS-20250306093032
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: 04/10/2025
NARRATIVE
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Facility does not employ required staff for the residents in care.

It was alleged that the facility is operating with one staff during night shift as the facility is approved by the North Los Angeles Regional Center (NLARC) to provide 2:1 staffing services to C1, and 1:1 staffing services to two (2) out of four (4) clients for 24 hours. Furthermore, only one client requires 1:1 staffing services during the day/12 hours. To investigate this allegation LPA conducted interviews with the Administrator and four staff who denied the allegation and informed LPA that the facility always adheres to the approved staffing ratio to clients and never provided one staff during the night shifts at all. Additionally, LPA conducted interviews with four (4) out of four (4) clients who informed LPA that during the time of the incident which occurred on 02/28/2025 relating to C1, initially, there was only one staff available for the night shift. However, two other staff and the Administrator arrived after the incident occurred. LPA was also informed that mostly during night shifts there is only one staff available for four (4) clients. LPA conducted a review of facility program where it stated that the facility would provide 24 hours, 7 days a week staffing ratio of one staff per two clients. Based on the interviews and facility program review this allegation is Substantiated.

A deficiency was issued per California code of Regulations Title 22 or Health and Safety Code. See 9099D included with this report.

Appeal rights issued. Exit interview conducted. Copy of this report signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250306093032
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: 04/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/17/2025
Section Cited
CCR
85078(a)(1)
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85078 (a) Responsibility for Providing Care and Supervision : (1) The licensee shall provide those services identified in the client's needs and services plan as necessary to meet the client's needs. This requirement is not met as evidenced by:
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The Administrator agreed to update the staff schedule (LIC500) and Clients' In-Home schedule to meet all clients needs and services. Administrator will also submit one week daily sign in and sign out sheets of scheduled staff to LPA.
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Based on the information obtained through interviews the Licensee did not comply with the seciton cited above by not providing approved 24 hour 2:1 staffing services to C1 and 1:1 staffing services to other two clients in care which poses 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: 04/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3