197609804-8-20-2025-31-AS-NGID-DLCM52-20250909091735

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609804
Report Date: 08/20/2025
Date Signed: 08/20/2025 03:11:32 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
08/14/2025 and conducted by Evaluator Huma Rahimi

COMPLAINT CONTROL NUMBER: 31-AS-20250814090836

FACILITY NAME:	ALLIANCE ADULT RESIDENTIAL HOMES INC		FACILITY NUMBER:	197609804
ADMINISTRATOR:	OLIVIA RUCIBIGANGO		FACILITY TYPE:	735
ADDRESS:	7821 HESPERIA AVENUE		TELEPHONE:	(747) 254-4154
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	4	CENSUS: 3	DATE:	08/20/2025
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Olivia Rucibigango, Administrator		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Staff did not seek timely medical attention for client in care.

INVESTIGATION FINDINGS:

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At 2:00 PM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced initial complaint visit. LPA met with staff, Patrick Mugenyi, and Administrator was contacted via telephone. The Administrator arrived shortly after and LPA explained the reason for the visit.

During course of the investigation, interviews and record review were made. At 2:05 PM, LPA requested client and staff roster. At 2:10 PM, LPA requested copies of pertinent information which include, but not limited to Physician Report, Admission Agreement, Appraisal Needs and Service Plan, Lab Order etc., relevant to the investigation. At approximately 2:15 PM, LPA conducted a physical plant tour. Between 2:20 PM – 3:15 PM, LPA conducted an interview with the Administrator , two (2) staff, and one (1) out of three (3) clients who were avaliable.

Continue on LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025

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-20250814090836

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: 08/20/2025

NARRATIVE

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Staff did not seek timely medical attention for client in care.

It was alleged that on 08/10/2025, Client #1 (C1) scratched his/her left arm, left ear lobe, and choked him/herself with a charger cable and no medical attention was provided. To investigate this allegation LPA conducted an interview with the Administrator and was informed that due to C1’s upcoming lab test on 09/05/2025, C1’s Physician ordered/instructed the facility staff not to provide any type of energy drinks. During today’s visit, LPA obtained a copy of C1’s Doctor’s order. Moreover, LPA was informed that on 08/10/25, C1 refused to follow the doctor’s order and demanded to have an energy drink. Interview with two (2) staff revealed that they tried to redirect C1 but C1 went back into his/her room, slammed the door and started throwing things (plates and a cup), on the wall. LPA was informed that staff followed C1 into his/her room and continued to redirect C1. After, C1’s behavior normalized, staff noticed minor scratches on C1’s left arm only and no marks of chocking or ear scratches were observed. During the interview with the Administrator and two (2) staff members it was revealed that an immediate first aid of cleaning/sanitizing and applying a bandage was provided to C1. LPA was also informed that C1 refused any medical attention. After the incident, C1 played games, took night medication and went to sleep. All parties interviewed denied ever hearing or witnessing C1 chocked or scratched his/her ear. Interview with C1 confirmed that on the day of the incident, no major injuries were sustained that required a medical attention. Therefore, based on interviews and record reviews this allegation is deemed Unsubstantiated at this time.

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

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025

LIC9099 (FAS) - (06/04)

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