197610131-9-16-2025-31-AS-MGFS-DVQUSD-20260706155009

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610131
Report Date: 09/16/2025
Date Signed: 09/16/2025 03:45:35 PM

Unsubstantiated

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
07/23/2025 and conducted by Evaluator Evelin Rios

COMPLAINT CONTROL NUMBER: 31-AS-20250723091427

FACILITY NAME:	REM CALIFORNIA LLC - DESERT HILLS		FACILITY NUMBER:	197610131
ADMINISTRATOR:	ASOMBANG, PERPETUA		FACILITY TYPE:	735
ADDRESS:	8241 WEST AVENUE C-14		TELEPHONE:	(818) 415-4301
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY:	4	CENSUS: 4	DATE:	09/16/2025
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Perpestua Asombang		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff left resident in soiled diapers/linens for extended period of time.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 09/16/2025, in conjuntion to Complaint Control #31-AS-20250911140508, Licensing Program Analyst (LPA) Evelin Rios arrived at the facility to conduct an unannounced subsequent complaint visit. LPA was granted entry by staff. LPA met with the Program Director, Perpetua Asombang and LPA explained the reason for the visit was to continue the investigation on the above allegation.

At approximately 9:30 a.m., LPA attempted to interview Client #3 (C3) but they refused to be interviewed. LPA attempted to interview Client #1 (C1) but they did not respond to LPA's questions. At 10:00 a.m., LPA interviewed Client #4 (C4). At 1:05 p.m. LPA Rios reviewed the evidence for this report and obtained copies of staff notes regarding C1 for 07/09/2025, 07/16/2025 and 07/17/2025. At 1:25 p.m., LPA Rios interviewed two (2) staff that provide care to C1. At approximately 2:10 p.m., LPA interviewed a third staff that provides care to C1.
(Continue to LIC9099-C)

Unsubstantiated

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 2

Control Number 31-AS-20250723091427

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

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(Continued from LIC9099)
Allegation: Staff left resident in soiled diapers/linens for extended period of time. It is alleged that Staff #1 (S1) did not ensure their client and client's bedsheets were dry from urine before leaving their shift. To investigate the allegation on 08/01/2025 at 1:40 p.m., LPA requested and obtained copies of C1's Physician's Report (LIC602), Individual Program Plan (IPP) meeting date 03/10/2025, Quarterly Progress Report and staff notes regarding C1 from 07/22/2025 to 07/31/2025. At approximately 2:00 p.m., LPA also conducted a physical plant tour of the facility and from 2:30 p.m. to 3:24 p.m., LPA interviewed Client# 2 (C2), the administrator and Staff #1 (S1) that provides care to C1.

LPA's interview with the administrator on 08/01/2025, revealed one Client #1 (C1) will drink a lot of water in the day and before bed which may cause C1 to have accidents. Staff is directed to prompt C1 to use the bathroom during the night. LPA's review of C1's IPP and LIC602 confirmed C1 requires support in the bathroom and sleeps in incontinence underwear due to bladder impairment. According to C1's IPP staff will wake them up at night to use the bathroom to avoid bedwetting. LPA did not find another client, other than C1, who requires assistance with toileting.

LPA's interview with four (4) out of four (4) staff corroborate C1 may have accidents morning and/or night. Interview with one (01) staff out of four (4) revealed they have started their shift and have found C1 in a wet undergarment. When staff was asked if it was concerning, staff stated not verbatim it was not concerning and is appeared as if C1 had just had the accident. Staff stated they woke C1 up for a shower and washed C1's bedding. During LPA's interview with C2, they revealed they have not witnessed an incident as described in the allegation but that C1 will smell like urine. C2 did not provide further details. LPA's review of staff notes regarding C1 for July 2025, specifically during the period when S1 was on shift, did not contain any concerning information related to the complaint. However, records did confirm that C1 was showered and routinely awakened at night to use the bathroom. Based on interviews conducted and records reviewed the allegation is deemed Unsubstantiated at this time.

No health or safety issues observed. Exit interview conducted. A copy of this 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 2