197610131-8-1-2025-31-AS-NGID-DN72CS-20251106161714

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610131
Report Date: 08/01/2025
Date Signed: 08/01/2025 04:04:33 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
04/15/2025 and conducted by Evaluator Evelin Rios

COMPLAINT CONTROL NUMBER: 31-AS-20250415164256

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:	08/01/2025
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Program Director, Perpetua Asombang		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff inappropriately restrained resident.

INVESTIGATION FINDINGS:

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On 08/01/2025 at 1:30 p.m., Licensing Program Analyst (LPA) Evelin Rios arrived at this facility to conduct an unannounced subsequent complaint visit to continue the investigation and deliver a determination on 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 2:00 p.m., LPA conducted a physical plant tour of the facility. LPA did not observe any health or safety issues.

Allegation: Staff inappropriately restrained resident. It was alleged that staff restrained client #1 (C1) by grabbing their arms, forcing them behind them, and bringing them to the ground. To investigate the allegation LPA Rios conducted an initial complaint visit on 04/21/2025. During that visit, on 04/21/2025 at 10:34 a.m., LPA interviewed staff #4 (S4) by telephone. (Continue to LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025

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-20250415164256

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: 08/01/2025

NARRATIVE

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(Continued from LIC9099)
On 04/21/2025 at 11:10 a.m., LPA Rios requested and obtained copies of relevant documents including, but not limited to, the following: client roster, personnel report, C1's physician’s report, Individual Program Plans (IPP), IPP addendums, quarterly progress reports, REM Annual Report dated 03/31/2025 and Special Incident Reports (SIRs) submitted to Community Care Licensing (CCL) from April 2025 regarding C1. On 04/21/2025 at approximately 12:10 p.m., LPA conducted a physical plant tour of the facility. While conducting the physical plant tour, LPA attempted to interview client #2 (C2) but they refused to be interviewed. Client #3 (C3) and Client #4 (C4) were out in the community. At 12:14 p.m., LPA Rios conducted an interview with staff #3 (S3). At 12:56 p.m., LPA interviewed C1.

On today's visit, LPA Rios interviewed Staff #1 (S1) and Staff #2 (S2). LPA's interview with C1 revealed that on 04/13/2025, S1 was late to take them on an outing, which made C1 upset. According to C1, staff did not attempt to de-escalate the situation and instead immediately restrained them. However, LPA's interviews with the three (03) staff members (S1, S2, S3) present on that day revealed that staff did not physically restrain C1. Instead, staff reported they gave C1 space and allowed time for them to calm down. The three (03) staff present confirmed C1 was exhibiting aggressive behavior. LPA's interview with S1 corroborated that C1 became upset because they were late for an outing. Interviews with the three (03) staff present corroborate C1 was making verbal threats and using racial slurs toward staff and eventually S3 was able to approach C1 and calm them down after they provided distance between them and C1. Based on interviews conducted, there is insufficient evidence to support the allegation that staff inappropriately restrained resident. Therefore, the allegation is deemed Unsubstantiated at this time.

No deficiencies cited. Exit interview conducted, a copy of this report was signed and delivered.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025

LIC9099 (FAS) - (06/04)

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