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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609804
Report Date: 09/07/2022
Date Signed: 09/07/2022 05:42:35 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/24/2022 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20220624085032
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:
09/07/2022
UNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Jackline KwagaTIME COMPLETED:
05:56 PM
ALLEGATION(S):
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Staff are not adequately supervising resident
Medications were accessible to resident
INVESTIGATION FINDINGS:
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At 4:15 p.m. on 09/07/2022 Licensing Program Analyst (LPA) Nicholas Reed conducted a subsequent complaint visit. LPA met with staff and disclosed the reason for the visit.

Staff are not adequately supervising resident

Regarding the allegation above, it was alleged Client #1 (C1) left the facility without supervision. On 06/28/2022 at 3:50 p.m. the Administrator stated there is no way C1 could have gotten out unsupervised as all 3 facility exits have auditory alarms. C1 was interviewed at 11:10 a.m. on 07/21/2022 and claimed they would leave the facility unsupervised in the afternoon and night and acquired sleeping medication for about 2 months. In interviews with staff on 08/17/2022 at 2:45 p.m. and 2:55 p.m., Staff #1 (S1) and Staff #2 (S2) stated C1 has never left the facility unattended and always has a 1:1 staff supervising. A file review was conducted on 08/10/2022 in which C1’s Day Program reported that C1 left the facility unsupervised on 08/09/2022 with Client #2 (C2).
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022
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 2
Control Number 31-AS-20220624085032
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ALLIANCE ADULT RESIDENTIAL HOMES INC
FACILITY NUMBER: 197609804
VISIT DATE: 09/07/2022
NARRATIVE
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 In an interview on 08/17/2022 at approximately 3:35 p.m. C2 stated they did not leave the facility with C1 and the allegation was false. Based on interviews and file review, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANIATED at this time.

Medications were accessible to resident

Regarding the allegation above, it was alleged unprescribed medication was accessible to C1. On the morning of 06/23/2022 at approximately 8:30 a.m. Day Program staff found approximately 50 empty medication packages under C1’s mattress. C1 was interviewed at 4:10 p.m. on 06/28/2022 and again at 11:10 a.m. on 07/21/2022. From interviews, C1 stated they acquired the sleeping medication over 2 months when they snuck out of the facility. C1 said they ingested the medication both away from and at the facility, so staff never saw. C1 was taken to the doctor that morning, and no medication was found in their system. A record review at 5:30 p.m. on 09/07/2022 confirmed that none of the medications under C1’s bed were in their system. Based on interviews, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANIATED at this time.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2