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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197610137
Report Date:
10/29/2021
Date Signed:
10/29/2021 11:41:33 AM
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
10/22/2021
and conducted by Evaluator
Wendell Smith
COMPLAINT CONTROL NUMBER:
31-AS-20211022165949
FACILITY NAME:
REM CALIFORNIA LLC - OSBORNE
FACILITY NUMBER:
197610137
ADMINISTRATOR:
IBRAHIM, MOSHOOD
FACILITY TYPE:
735
ADDRESS:
15952 OSBORNE ST
TELEPHONE:
(818) 893-1234
CITY:
NORTH HILLS
STATE:
CA
ZIP CODE:
91343
CAPACITY:
4
CENSUS:
3
DATE:
10/29/2021
UNANNOUNCED
TIME BEGAN:
09:00 AM
MET WITH:
Dominique Anderson
TIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not safeguard resident's personal belongings
Staff threatened resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced complaint visit to investigate the allegations above. LPA met with facility staff and explained the reason for this visit.
Staff did not safeguard resident's personal belongings
It is alleged that client # 1 (C1) had a coupon sent to them in the mail and may not have received the coupon. It is also alleged that staff threw away a calendar that was on C1's wall. Interviews were conducted with C1 and facility staff from approximately 9:15-9:45am regarding this allegation. LPA also obtained copies of a receipt when C1 went to use the coupon that was given to them. Interviews revealed that C1 did receive the coupon sent to them and was able to use the receipt on 10/26/21. LPA conducted a walk through of C1's room at approximately 10:15 am and LPA was able to observe several calendars in C1's room. Interview with C1 revealed that there was no calendar that was threw away by staff. Based on the information obtained through interviews and observation this allegation is deemed Unsubstantiated at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME
:
Cassandra Harris
LICENSING EVALUATOR NAME
:
Wendell Smith
LICENSING EVALUATOR SIGNATURE
:
DATE:
10/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/29/2021
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-20211022165949
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 - OSBORNE
FACILITY NUMBER:
197610137
VISIT DATE:
10/29/2021
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
Staff threatened resident.
It is alleged that staff #1 (S1) has threatened C1 about telling someone he received a card or coupon. LPA conducted interviews with C1 and S1 regarding this allegation. C1 stated they were not threatened by C1 about their card or anything else. Based on the information obtained this allegation is deemed Unsubstantiated at this time.
Exit Interview conducted.
SUPERVISORS NAME
:
Cassandra Harris
LICENSING EVALUATOR NAME
:
Wendell Smith
LICENSING EVALUATOR SIGNATURE
:
DATE:
10/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/29/2021
LIC9099
(FAS) - (06/04)
Page:
2
of
2