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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609924
Report Date: 09/10/2025
Date Signed: 09/10/2025 02:47:52 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
09/02/2025 and conducted by Evaluator Lorena Casillas
COMPLAINT CONTROL NUMBER: 31-AS-20250902173352
FACILITY NAME:DIVINE FUTURES IVFACILITY NUMBER:
197609924
ADMINISTRATOR:VASHAN BOBNEYFACILITY TYPE:
735
ADDRESS:3525 E GARNET LANETELEPHONE:
(818) 270-6434
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:4CENSUS: 4DATE:
09/10/2025
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Vashan BobneyTIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Uncleared adults are working at the facility.
INVESTIGATION FINDINGS:
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On 09/10/2025 at 09:15 AM Licensing Program Analyst (LPA), Lorena Casillas conducted an unannounced complaint visit to investigate the above stated allegation. LPA was accompanied by North Los Angeles Regional Center (NLARC) Community Services Specialist (CSS) Rachel Cooper. LPA and CSS met with Administrator Vashan Bobney and explained the reason for the visit.

At 10:15 AM LPA Casillas conducted a physical plant tour with the Administrator. During the investigation, interviews and record reviews were conducted from 10:30 am to 2:00 pm. LPA requested client roster, LIC 500, Bond and Administrator Certificate. LPA requested copies of pertinent information relevant to the investigation including, but not limited to, client records, medical records, medication logs, staff files, and any other information pertaining to client care. Four (4) clients were present during the visit.

Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025
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-20250902173352
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: DIVINE FUTURES IV
FACILITY NUMBER: 197609924
VISIT DATE: 09/10/2025
NARRATIVE
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Allegation: Uncleared adults are working at the facility.

It is alleged that there is uncleared adults working at the facility. Regarding this allegation it is reported that there are staff members providing one on one (1:1) care to clients without a proper background clearance. LPA interviewed Administrator and it was revealed that Staff #1 (S1) has been proving care and supervision to Client #1 (C1) on Thursdays, Fridays, Saturdays and Sundays from seven (7) pm to seven (7) am for a period of approximately one (1) year. Administrator admitted to not clearing S1 prior to allowing S1 to provide care and supervision, depending only on third party vendor Right Choice In Home Care sending S1 to the facility. LPA reviewed Guardian background website and it was determined that S1 does not have a criminal background clearance, therefore not allowed to provide direct care and supervision to C1. Based on record reviews and interviews this allegation is deemed substantiated.

A civil penalty was issued. Exit interview conducted and copy of report provided to Administrator.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 31-AS-20250902173352
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: DIVINE FUTURES IV
FACILITY NUMBER: 197609924
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/11/2025
Section Cited
CCR
80019(e)(2)
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(e)All individuals subject to a criminal record review pursuant to …shall prior to working, residing or volunteering in a licensed facility: (2)Obtain a California clearance or a criminal record exemption as required by the Department.This requirement is not met as evidenced by:
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Administrator contacted S1 to let them know that they are not allowed to return to the facility. Furthermore Administrator agrees and will send in writing via email to LPA the understanding that moving forward there will be no uncleared adults allowed to work in the facility.
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Based on observation and record review one (1) staff has worked at the facility providing direct care to clients without a fully processed criminal record clearance. This poses an immediate risk to the health and safety of 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: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025
LIC9099 (FAS) - (06/04)
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