197610137-3-27-2025-31-AS-NMAN-DFEREC-20250404125720

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610137
Report Date: 01/27/2025
Date Signed: 03/27/2025 01:53:34 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
01/17/2025 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20250117144918

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:	01/27/2025
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Gboyega Akinbola- designee		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Facility staff did not intervene timely between clients who are behaving aggressively.

INVESTIGATION FINDINGS:

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This is an amendment to the original report issued on 1.27.2025. Additional information was added to clarify the investigation.

Licensing Program Analyst (LPAs) Leslie Ngo-Castaneda and Nadia Shahbazian conducted a initial complaint visit to the facility to investigate the above allegations. LPAs met with the designee Gboyega Akinbola and advised them about the visit. At 1:18 PM LPA conducted a physical plant tour to ensure the health and safety of the clients in care.

An entrance interview was conducted.

It was being alleged that the facility staff did not intervene to control resident #1 (C1s) aggressive behavior towards other individual/client.
Continue to LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025

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-20250117144918

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: REM CALIFORNIA LLC - OSBORNE	FACILITY NUMBER: 197610137
	VISIT DATE: 01/27/2025

NARRATIVE

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During administrator and staff interview conducted at 12:43 PM staff unanimously stated there was no aggressive behaviors between clients. Applied Behavioral Therapist (ABA) was the one who started being aggressive towards C1. Administrator and staff #6 (S6) were with C1 at the facility when the incident happened on 1.16.2025. During the incident C1 was very upset with the ABA and took a broom and tried to swing it at the ABA.

At 12:45 PM LPAs interview two (2) out of three (3) clients who were in the facility and stated that they are happy with living at the facility and had no knowledge about an incident. At 1:00 PM LPAs requested and reviewed C1’s facility records, included but not limited to Physician report, Service Plan, IPP, Progress Report and other pertinent records. A review of facility records did not reveal any information to support the allegation. During this visit LPA's witness staff being with the client the whole time as their one (1) on one (1) care.

Based on the observation, interviews, and record review, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Exit interview conducted, copy of this report was given.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025

LIC9099 (FAS) - (06/04)

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