197609804-9-8-2022-31-AS-MVAO-CKSV6Y-20221102161019

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609804
Report Date: 09/08/2022
Date Signed: 09/08/2022 02:35:56 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
08/18/2022 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20220818142320

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:	09/08/2022
		UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Krisha Wakabi		TIME COMPLETED:	02:50 PM

ALLEGATION(S):

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Staff inappropriately restrained resident resulting in contusion.
Staff hit resident in care.

INVESTIGATION FINDINGS:

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At 2:20 p.m. on 09/08/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced subsequent complaint visit. LPA met with staff and disclosed the reason for the visit.

Staff inappropriately restrained resident resulting in contusion.

Regarding the allegation above, it was alleged Staff #1 (S1) and Staff #2 (S2) restrained Client #1 (C1) while S2 put their knee in C1’s back which caused a contusion of the ribs. The case was referred to the Investigations Branch (IB) on 08/18/2022 and was returned to the Woodland Hills-South Regional Office for a full investigation. LPA Wendell Smith conducted an initial visit on 08/19/2022 at 9:30 a.m. LPA Nicholas Reed interviewed clients and staff on 09/07/2022 from 10:45 a.m. to 5:15 p.m. From interviews, clients and staff reported conflicting accounts of what occurred, though no one mentioned staff putting their knee on the back of C1. Client #2 (C2) saw S1 and S2 on C1’s back with their hands on C1.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

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-20220818142320

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: 09/08/2022

NARRATIVE

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Client #3 (C3) stated S2 was not in the room, and C1 was aggressive towards S1 and S1 “put [C1] down gentle”. S1 stated C1 was aggressive towards them, and while scratching at S1’s hands and arms, S1 pulled away, which led to C1’s falling on a wooden plank. S2 stated S1 and S2 stood only at the doorway and were never in the room. S2 confirmed that C1 scratched S1 and fell after doing so. At 5:15 p.m. on 09/07/2022 LPA reviewed a photograph of S1’s right hand showing 2 small scratches. Further interviews with Staff #3 (S3), Staff #4 (S4), and Staff #5 (S5) revealed no bruising or swelling was observed on C1 after the incident. From record review at 11:40 a.m. on 09/07/2022, medical reports from 08/17/2022 and 08/24/2022 at Sherman Oaks Hospital revealed no rib fracture, and the possible sources of pain as constipation, gall stones, and kidney stones. Based on interviews and record 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.

Staff hit resident in care.
Regarding the allegation above, it was alleged S1 punched C1 in the back of the head after C1 became belligerent. From interviews, all staff and clients confirmed there was no punch thrown by S1. S1 further stated that C1 has a history of false allegations. On 08/19/2022 at approximately 1:00 p.m. a credible source interviewed C1 and was told that S1 put their knee in C1’s back, not S2 as originally reported. C1 also did not mention S1 punching them. 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. Appeal rights discussed. Copy of report issued.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

LIC9099 (FAS) - (06/04)

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