197610133-3-10-2025-31-AS-NMAN-DF4MTX-20250325095416

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610133
Report Date: 03/10/2025
Date Signed: 03/10/2025 02:48:35 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/07/2025 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20250307134514

FACILITY NAME:	REM CALIFORNIA LLC - NAPA		FACILITY NUMBER:	197610133
ADMINISTRATOR:	IBRAHIM, MOSHOOD		FACILITY TYPE:	735
ADDRESS:	16214 NAPA ST		TELEPHONE:	(818) 892-2800
CITY:	NORTH HILLS	STATE: CA	ZIP CODE:	91343
CAPACITY:	4	CENSUS: 4	DATE:	03/10/2025
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Gboyega Akinbola, Administator		TIME COMPLETED:	03:25 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident was sexually abuse.

INVESTIGATION FINDINGS:

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

At 12:00pm, Licensing Program Analyst (LPA), Angela Panushkina, arrived at REM – Napa in response to the above-mentioned allegation. LPA met with the Administrator and explained the reason for the visit.

At 12:05pm, LPA requested resident and staff roster. At 12:10pm requested copies of pertinent information which include, but not limited to Physician’s report, Admission Agreement, Individual Program Plan (IPP), Staff Training, Abuse Policy, relevant to the investigation. At approximately 12:15pm, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected. Between 12:20pm – 03:00pm, LPA conducted an interview with the Administrator, three staff and one (1) out of four (4) clients, who were able to communicate. LPA also obtained a contact information for the potential suspect and conducted a telephonic interview.
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025

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-20250307134514

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 - NAPA	FACILITY NUMBER: 197610133
	VISIT DATE: 03/10/2025

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

Allegation: Resident was sexually abused.

It was alleged that facility client #2 (C2) that lives in another home came into client #1 (C1’s) room and rapped C1. Interview with the Administrator revealed that C2 never lived at this location. C1 met C2, just once, during the Halloween party (October 2024). C1 asked C2 for the phone number but C2 refused. Administrator also informed LPA that due to C1’s mental status, C1 may say/see things that never happened. LPA conducted interviews with three (3) staff members who confirmed the statement provided by the Administrator. One (1) out of four (4) clients interviewed were unable to corroborate with the allegation. Moreover, C1 denied being sexually abused by C2 or others. In addition, at 12:40pm LPA contacted an interview with the potential suspect (C2), who also denied the above allegation and informed LPA that they have not seen, spoke nor had any contact with C1. Lastly, LPA conducted review of facilities daily notes and observed that C1’s statements are inconsistent and there is no supporting information. During today’s visit, LPA did not receive any corroborating evidence or testimony to support this allegation. Therefore, this allegation is deemed Unsubstantiated, at this time.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2