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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610132
Report Date: 12/02/2021
Date Signed: 12/02/2021 11:40:27 AM

Document Has Been Signed on 12/02/2021 11:40 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:REM CALIFORNIA LLC - 27TH STREETFACILITY NUMBER:
197610132
ADMINISTRATOR:DAY, DANSHELLEFACILITY TYPE:
735
ADDRESS:43778 27TH STREET WESTTELEPHONE:
(818) 363-3333
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 4CENSUS: 4DATE:
12/02/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Moshood IbrahimTIME COMPLETED:
11:55 AM
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At 10:20 a.m., Licensing Program Analysts (LPAs) Melissa Ruiz and Angela Panushkina conducted an unannounced Case Management visit at the facility mentioned above. The purpose of this visit was in relation to information revealed regarding a client (C1) during a previous complaint visit conducted on 10/06/21. Upon entry, LPAs were greeted by the Administrator Moshood Ibrahim. The purpose of this visit was explained.

During the previous visit, Administrator Moshood stated C1 had expressed multiple times that they wanted to be relocated to a different facility. Additionally, Administrator provided LPAs with multiple incident reports, submitted by the facility regarding C1. Based on observation today, it is revealed that C1 still lives at this facility.

Upon interviewing the Administrator, staff and C1, LPAs were informed that North Los Angeles County Regional Center (NLACRC) were involved in the process of relocating C1 to a different facility. Today, C1 stated they no longer wish to be relocated and want to remain at this facility. Interviews revealed that C1 was assigned to a new therapist from McKinley who has made progress with their behavior. In addition, NLACRC’s Service Coordinator is actively working on finding a new day program for C1. Lastly, interviews with two out of four residents revealed that C1 has been getting along with other clients.

No deficiencies were observed at this time. Exit interview conducted and report delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Melissa Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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