197610131-2-24-2025-31-AS-EMIR-DGQPS7-20250516113354

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610131
Report Date: 02/24/2025
Date Signed: 02/24/2025 04:00:02 PM

Unsubstantiated

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
01/13/2025 and conducted by Evaluator Evelin Rios

COMPLAINT CONTROL NUMBER: 31-AS-20250113152315

FACILITY NAME:	REM CALIFORNIA LLC - DESERT HILLS		FACILITY NUMBER:	197610131
ADMINISTRATOR:	IBRAHIM, MOSHOOD		FACILITY TYPE:	735
ADDRESS:	8241 WEST AVENUE C-14		TELEPHONE:	(818) 415-4301
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY:	4	CENSUS: 3	DATE:	02/24/2025
		UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Perpetua Asombang / Program Director		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff did not ensure that a resident's incontinence needs were met.

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. At 12:20 p.m. LPA Rios reviewed the evidence for this report.

Allegation: Staff did not ensure that a resident's incontinence needs were met. It is alleged that on 01/8/2025, Staff #1 (S1) left client #1 (C1) in a soiled undergarment. To investigate the allegation on 01/21/2025 at approximately 10:40 a.m., LPA conducted a physical plant tour of the facility. LPA did not observe any health or safety issues. While conducting the tour LPA attempted to interview, Client #1(C1). C1 did not respond to questioning. On 01/21/2025 LPA attempted to interview Client #2 (C2). C2 refused to be interviewed. LPA interviewed Client #3 (C3). At approximately 11:00 a.m., LPA requested and obtained copies of C1's Physician's Report (LIC602), Individual Program Plan (IPP) and Quarterly Progress Report.
(Cont. to LIC9099-C)

Unsubstantiated

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)

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Control Number 31-AS-20250113152315

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 from LIC9099) On 01/21/2025, at approximately 11:30 a.m. LPA interviewed client #4 (C4) when they arrived to the facility. On 01/21/2025 LPA interviewed a total of eight (8) staff, seven (7) in person and one (1) via telephone. LPA conducted one (1) staff interview via telephone on 01/23/2025. On today's visit LPA obtained a copy S1's time sheet for 01/08/2025.

LPA's review of C1's Quarterly Progress Report and LIC602 confirmed C1 requires support in the bathroom and sleeps in incontinence underwear due to bladder and bowel impairment. LPA's review of IPP revealed staff will wake C1 at night to use the bathroom to avoid bedwetting.

LPA's interview with ten (10) out of ten (10) staff corroborate C1 will point or will say a word to indicate they have to use the bathroom. Interview with staff that state they have assisted C1 with toileting corroborate they have to prompt C1 often to use the bathroom to avoid accidents. Interview with one (1) out of two (2) clients that were interviewed denied witnessing the allegation. LPA's Interview with C4 affirmed they witnessed, S1 sit C1 in a urinated undergarment on their chair while S1 went to the kitchen to eat before returning to change C1. C4 could not recall date of incident. LPA's interview with two (2) staff revealed, C4 made a statement to them regarding, witnessing the incident. LPA's interview with ten (10) staff including those that worked on the shift the alleged incident occurred revealed they had not witnessed the alleged incident. Interview with one (1) staff states they had observed S1 lacking in providing assistance while covering a shift in the past. Interview with the Program Director, revealed the facility had investigated the incident and found that S1 was not working during the time the incident was reported to them to have happened and have not received any complaints about S1 similar to this alleged incident. LPA's review of time sheet records did confirm S1 was working on 01/08/2025. LPA's interview with S1, denied the allegation. LPA could not find another individual to corroborate the allegation. Based on interviews conducted the allegation is deemed Unsubstantiated at this time.

Exit interview conducted a copy of this report signed and delivered. Program Director requested report be emailed.

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)

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