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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610131
Report Date: 02/24/2025
Date Signed: 02/24/2025 03:58:09 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
01/07/2025 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20250107132520
FACILITY NAME:REM CALIFORNIA LLC - DESERT HILLSFACILITY NUMBER:
197610131
ADMINISTRATOR:IBRAHIM, MOSHOODFACILITY TYPE:
735
ADDRESS:8241 WEST AVENUE C-14TELEPHONE:
(818) 415-4301
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:4CENSUS: 3DATE:
02/24/2025
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Perpetua Asombang / Program DirectorTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Facility staff spoke inappropriately to resident.
INVESTIGATION FINDINGS:
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On 02/24/2025 at 10:05 a.m., Licensing Program Analyst (LPA) Evelin Rios arrived at the facility. LPA was granted entry by staff. LPA met with the Program Director, Perpetua Asombang and LPA explained the reason for the visit was to deliver the determination on the above allegation.

Allegation: Facility staff spoke inappropriately to resident. It is alleged Staff #1 (S1) and Staff 2 (S2) yelled at and called Client #1 (C1) a "bitch". To investigate the allegation LPA Rios conducted an initial complaint visit on 01/10/2025. On 01/10/2025 at approximately 1:00 p.m., LPA obtained copies of the personnel report (LIC500), staff schedule, and individual face sheets for clients. LPA also reviewed C1’s facility record. On 01/10/2025 from 1:30 p.m. to 3:33 p.m., LPA interviewed three (3) clients; C1, client #2 (C2), client #4 (C4) and eight (8) staff. Client #3 (C3) did not respond to LPA’s questions. On 01/10/2025 at approximately 3:35 p.m. LPA conducted a physical plant tour of the facility. LPA did not observe any health or safety issues. (Cont. to LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2025
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-20250107132520
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: REM CALIFORNIA LLC - DESERT HILLS
FACILITY NUMBER: 197610131
VISIT DATE: 02/24/2025
NARRATIVE
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(Continued form LIC9099) On 01/21/2025 LPA Rios conducted a subsequent visit and interviewed three (3) additional staff, two (2) in person and (1) via telephone. LPA obtained the following copies: staff contact list, C1’s Individual Program Plan (IPP), and C1’s Quarterly Progress Report. LPA conducted two (2) staff interviews via telephone on 01/14/2025, and 01/23/2025.

LPA’s interview with C1 confirmed that S2 has yelled at them, however they could not recall if S2 used the word "bitch", only that it was mean. LPA's interview with C1, revealed S2 will yell at them to stay in their room. Interview with two (2) out of three (3) clients deny witnessing S1 and S2 yell our use derogatory language towards C1. LPA's review of C1's IPP dated 3/27/2024 revealed, C1 is able to communicate their needs and advocate for themselves. LPA's review of C1's Quarterly Progress Report dated 10/22/2024, revealed C1 has engaged in untrustworthy behavior such as making false accusations. C1's IPP, however did not have information regarding false statements.

LPA’s interview with S1 and S2 deny the allegation. S1 referred to issues between staff that may have brought on the allegation. LPA's interview with the Program Director resulted in a denial of the allegations. Interview with the reporting party and two (2) out of fourteen (14) staff corroborate that they have witnessed S1 and S2 yell at C1 on different occasions. Reporting party and one (1) staff corroborate witnessing S1 and S2 call C1 a "bitch". Interview with witness statements were consistent with statements made by C1. Therefore, based on consistent and corroborative witness interviews, the allegation is Substantiated at this time.

Exit interview conducted, deficiency cited (refer to 9099D). Report reviewed, signed and delivered. Program Director requested report via email.


SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250107132520
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: REM CALIFORNIA LLC - DESERT HILLS
FACILITY NUMBER: 197610131
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/24/2025
Section Cited
CCR
80072(a)(1)
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80072 Personal Rights (a) each client shall have personal rights...(1)To be accorded dignity in his/her personal relationships with staff and other persons.

This requirement is not met as evidenced by:
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S1 and S2 had been placed on leave and are still on leave as of today's date. Program Director has had staff participate in training on Personal Rights of the clients and provided a sign-in sheet of staff that attended along with training topic(s) covered to LPA. POC cleared today.
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Based on interviews, the licensee did not comply with the section cited above, in which three (3) witnesses and one (1) client validated or witnessed staff members yell at client in care, which posed a potential health, safety or personal rights risk to persons in care.
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If S1 and S2 return to work Program Director will ensure they participate in Personal Rights of the clients training and provide a sign-in sheet to LPA.
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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: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3