197610131-4-21-2025-31-AS-EMIR-DHWU5V-20250623151722

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610131
Report Date: 04/21/2025
Date Signed: 04/21/2025 04:07:26 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
04/07/2025 and conducted by Evaluator Evelin Rios

COMPLAINT CONTROL NUMBER: 31-AS-20250407001545

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: 4	DATE:	04/21/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Perpetua Asombang (Program Director)		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff provided a client access to harmful materials while in care.
Staff did not provide adequate supervision to a client.

INVESTIGATION FINDINGS:

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On 04/21/2025 at approximately 10:25 a.m., Licensing Program Analyst (LPA) Evelin Rios arrived to the above mentioned facility. LPA was granted entry by one of the four (04) staff present. LPA met with the Program Director, Perpetua Asombang and LPA explained the reason for the visit. An entrance interview was conducted. Four (04) of four (04) clients were present. LPA requested a client roster and personnel report (LIC500). Jessica Hatley, Area Director arrived at the facility.

At 10:34 a.m., LPA interviewed staff #2(S2) by telephone. At approximately 11:10 a.m. LPA obtained copies of facility’s Individual Service Plan for Client #1(C1) dated 04/03/2024, C1’s physician’s report (LIC602) dated 02/13/2023 and facility’ s program regarding Service Outcomes. At approximately 12:10 p.m., LPA conducted a physical plant tour of the facility. LPA did not observe any health or safety issues. Cleaning products were observed locked under the kitchen sink. At 12:14 p.m., LPA Rios conducted an interview with one (01) staff that arrived at the facility. At 12:56 p.m., LPA interviewed C1.
(Continue to LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2025

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-20250407001545

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: 04/21/2025

NARRATIVE

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Allegations #1: Staff provided a client access to harmful materials while in care.
Allegation #2: Staff did not provide adequate supervision to a client.

It was alleged staff #1 (S1) provided Client #1 (C1) with cleaning products and then left C1 unsupervised with the cleaning products. To investigate the allegation LPA Rios and LPA Casillas conducted an initial complaint investigation on 04/15/2025. On 4/15/2025 at approximately 11:40 a.m., LPA Casillas conducted a physical plant tour of the facility. LPA did not observe any health or safety issues. Also, on 04/15/25, at 11:56 a.m., LPA Rios attempted to interview client #2(C2). C2 declined to be interviewed. At approximately 12:00 p.m., LPA Rios requested and obtained copies of C1’s Individual Program Plan (IPP) from 01/30/2023 with addendums, and Quarterly Progress Report from consulting behaviorist dated 09/15/2024. At approximately 12:13 p.m., LPA attempted to interview client #3 (C3), C3 did not respond to LPA's questions. At 12:14 p.m., LPA Rios interviewed client #4(C4). At 1:21 p.m., LPAs interviewed a total of four (04) staff.

According to the Program Director (PD) clients do not handle chemicals such as cleaning products. PD also stated, when clients do participate in house cleaning staff will pre-mix cleaners in the mop bucket or spray the surface themselves. Interview with six (6) staff corroborates that when clients assist in cleaning the facility such as bedrooms, kitchen and bathrooms the staff handle the cleaning products and the clients are always supervised. However, LPA’s interview with C1 supported the allegation, stating that S1 provided them with a cleaning product and left them unsupervised. Conversely, LPA’s interview with S2 who was present on the day in question denied the allegation. According to S2, C1 became upset when S1 would not hand them the cleaning product. C1 was heard by S2 telling S1 they would get them fired. LPA's review of the facility program did not explicitly outline client participation in house chores but did include information on self-help and independence. Additionally, LPA’s review of C1’s Individual Program Plan (IPP) confirmed that C1 requires 1:1 supervision. The Quarterly Report also noted instances of C1 being triggered after making demands to staff regarding household chores. LPA's interview with C4; C4 denied both allegations, stating they are supervised when cleaning their bedroom and they use wipes to clean surfaces. LPA was unable to locate an additional witness to the allegation. Based on interviews, observations and document reviews the allegations, staff provided a client access to harmful materials while in care and allegation, and staff did not provide adequate supervision to a client are deemed Unsubstantiated at this time.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2025

LIC9099 (FAS) - (06/04)

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