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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610131
Report Date: 09/16/2025
Date Signed: 09/16/2025 03:34:35 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
09/11/2025 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20250911140508
FACILITY NAME:REM CALIFORNIA LLC - DESERT HILLSFACILITY NUMBER:
197610131
ADMINISTRATOR:ASOMBANG, PERPETUAFACILITY TYPE:
735
ADDRESS:8241 WEST AVENUE C-14TELEPHONE:
(818) 415-4301
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:4CENSUS: 4DATE:
09/16/2025
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Perpestua AsombangTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Facility staff did not prevent resident from gaining access to hazardous items that should be stored inaccessible.
INVESTIGATION FINDINGS:
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On 09/16/2025, Licensing Program Analyst (LPA) Evelin Rios arrived at this facility to conduct an unannounced complaint visit to investigate the above allegation. LPA was granted entry into the facility by staff. LPA met with the Program Director, Perpetua Asombang and explained the reason for the visit. An entrance interview conducted.

At approximately 9:10 a.m., Client #1 (C1) approached LPA and began sharing information unrelated to the current complaint. LPA proceeded to conduct an interview with C1. At approximately 9:18 a.m., LPA Rios along with the administrator conducted a physical plant tour of the facility. LPA observed the closet in question locked. Administrator had staff with the key to the closet open it. LPA observed hygiene products and a blue mat stored in the closet. LPA attempted to interview Client #2 (C2) but they refused to be interviewed. At approximately 9:30 a.m., LPA attempted to interview Client #3 (C3) but they did not respond to LPA's questions. At 10:00 a.m., LPA interviewed Client #4 (C4). From approximately 11:00 a.m. to 11:43 p.m., LPA interviewed four (4) staff. (Continue to LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
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-20250911140508
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: REM CALIFORNIA LLC - DESERT HILLS
FACILITY NUMBER: 197610131
VISIT DATE: 09/16/2025
NARRATIVE
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(Cont. from LIC9099) LPA reviewed and obtained copies of the client roster, Personnel Report (LIC 500), staff schedule around the time frame the initial complaint was made, Client #1’s (C1) Physician’s Report, and C1’s Individual Program Plan (IPP).

Allegation: Facility staff did not prevent resident from gaining access to hazardous items that should be stored inaccessible. It was alleged a staff allowed C1 to access staff keys and unlock a closet containing hazardous items. To investigate the allegation LPA Rios interviewed two (2) out of four (4) clients, four (4) staff and the administrator. LPA Rios also conducted a physical plant tour. During today's visit, LPA observed that both the closet designated for hygiene products and the cabinet under the sink storing cleaning supplies and poisons were locked.

During LPA's interview with the administrator, it was confirmed that hazardous items such as, Cockroach/Spider Killer spray and Clorox Urine Remover, were stored in a closet designated for hygiene products only. The administrator stated that staff should not have placed such items in that particular closet. However, the closet was locked, and the administrator believes a staff member may have intentionally provided the keys to C1 and taken the picture to make the facility look out of compliance. Interviews with two (2) out of four (4) staff members corroborated witnessing Staff #1 (S1) provide the facility keys to C1, to obtain items from the hallway closet. Additionally, one (1) staff member reported observing S1 give the keys to C1 without close supervision, noting that S1 was watching from a distance as C1 accessed the closet. During LPA's interview with C1, C1 denied the allegation. During LPA’s interview with Client #4 (C4), C4 stated that they had seen C1 with the facility keys. However, C4 was unable to say when they saw this occur, which staff had provided the keys, or if staff were providing close supervision at the time.

LPA Rios reviewed photos submitted to Community Care Licensing (CCL), which show C1 in possession of the facility keys. The keys were identified by the distinct lanyard attached to them. In the photos, C1 is seen opening the closet located in the hallway leading to clients' bedrooms, and in another picture the closet door is visibly wide open. On 08/26/2025 a credible witness conducted a visit to this facility and inspected the closet C1 reportedly accessed and discovered hazardous materials inside, including one can of cockroach killer, three cans of Clorox Urine Remover, and various hygiene products. Based on the credible witness and LPA's interview this allegation is Substantiated at this time.

Deficiency cited. Exit interview conducted. Appeal Rights provided. Copy of report provided.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250911140508
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: REM CALIFORNIA LLC - DESERT HILLS
FACILITY NUMBER: 197610131
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/10/2025
Section Cited
CCR
80087(g)
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80087 Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.
This requirement is not met as evidenced by:
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Cleaning solutions and poisons where locked in another cabinet prior to LPA's visit. Program Director agreed to have all staff complete vendorized training on the cited regulation and provide the vendor information and training certifications to LPA by POC due date 10/10/2025.
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Based on interviews, the licensee did not comply with the section cited above, in which C1 was given access to a closet that at the time had cleaning solutions and poisons, which posed a potential health, safety or personal rights risk to persons 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: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3