197609804-2-9-2026-31-AS-NGID-DRG25B-20260219160514

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609804
Report Date: 02/09/2026
Date Signed: 02/09/2026 01:15:45 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
08/27/2025 and conducted by Evaluator Huma Rahimi

COMPLAINT CONTROL NUMBER: 31-AS-20250827105419

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: 4	DATE:	02/09/2026
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Richard Kamiiza, Staff		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Resident eloped from the facility due to lack of staff supervision.

INVESTIGATION FINDINGS:

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At 9:10 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced subsequent complaint visit. LPA met with staff Richard Kamiiza, and the Administrator was contacted via telephone. LPA explained the reason for the visit. The Administrator informed LPA that they are unable to come to the facility and designated the staff to sign and receive today's report.
To investigate the allegation above LPA conducted an initial visit on 09/02/2025. LPA conducted interviews and reviewed records. At 10:55 AM, LPA requested the client and staff roster. At 11:00 AM, LPA requested copies of pertinent documents, including, but not limited to, Physician Reports, Admission Agreements, Appraisal of Needs and Service Plans, and Staff Training records relevant to the investigation. At approximately 11:05 AM, LPA conducted a physical plant tour. Between 11:15 AM and 2:15 PM, LPA conducted interviews with the Licensee, the Administrator, two (2) staff, and one (1) out of three (3) clients who were available. During today's visit, between 9:45 AM to 11:30 AM, LPA conducted additional interviews with 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: 02/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2026

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-20250827105419

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: 02/09/2026

NARRATIVE

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Allegation: Resident eloped from the facility due to lack of staff supervision.
It was alleged that facility staff failed to provide adequate supervision, which resulted in Client #1 (C1) eloping from the facility on 08/22/2025. To investigate this allegation, on 09/02/2025, LPA conducted interviews with the Administrator, Staff #1 (S1), Staff #2 (S2), and one (1) out of three (3) clients who were available. During a subsequent visit, LPA conducted interviews with three (3) out of four (4) clients who were available. During the 09/02/2025 interview with one (1) client, LPA was informed that he/she was able to tape the inside window alarm, exit the facility, walk to local stores, and return later that night. Both S1 and S2 reported they were on duty, remained awake, conducted hourly checks, and observed all clients, including C1, in their bedrooms throughout the night, and both staff and the Administrator confirmed that alarms were functioning. Lastly, interviews with three (3) clients on 02/09/2026 revealed they did not witness C1 leave, did not hear alarms, and reported staff presence overnight. Review of C1’s Individual Service Plan documented a history of false allegations and fabrication of stories. Based on interviews and documentation, this allegation is Unsubstantiated at this time.

Appeal rights explained and Exit interview conducted.

Copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2026

LIC9099 (FAS) - (06/04)

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