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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610137
Report Date: 03/21/2022
Date Signed: 03/21/2022 01:06:17 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
11/18/2021 and conducted by Evaluator Wendell Smith
COMPLAINT CONTROL NUMBER: 31-AS-20211118125922
FACILITY NAME:REM CALIFORNIA LLC - OSBORNEFACILITY NUMBER:
197610137
ADMINISTRATOR:IBRAHIM, MOSHOODFACILITY TYPE:
735
ADDRESS:15952 OSBORNE STTELEPHONE:
(818) 893-1234
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:4CENSUS: 4DATE:
03/21/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Monsuru AdetunjiTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff inappropriately restrained a client while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced subsequent visit to finish investigation into the allegation above. LPA met with facility staff and explained the reason for this visit.

It is alleged that client # 1 (C1) was inappropriately restrained which caused a swollen left elbow. Previous visit was conducted on 11/23/21. During that visit interviews were conducted with facility staff, North Los Angeles Regional Center (NLRC), and C1's behaviorist. Information from interviews revealed that C1 was having a behavioral episode on 11/6/21 at 9 am where staff had to use physical restraint to prevent C1 from hurting themself and others. Interviews revealed that staff did not restrain C1 inappropriately. Information from interviews revealed that C1 possibly injured their elbow before staff intervened. LPA attempted to interview C1 but C1 was unable to answer any questions. Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time.
Exit Interview conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2022
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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