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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610137
Report Date: 12/20/2022
Date Signed: 12/20/2022 11:02:23 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
07/28/2021 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20210728114416
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: 2DATE:
12/20/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Matthew Awofadeju & Eucharia OmoruyiTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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1. Staff handled resident in a rough manner
2. Resident was not served an adequate amount of food
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) conducted a subsequent visit to deliver the final findings of the allegations mentioned. The following was determined:

Allegation #1: Staff handled resident in a rough manner. On 08/05/2021 and 04/09/2022, from various times, ranging from 12pm to 3pm, LPA conducted interviews with staff. During today's visit, LPA conducted additional interviews from 10am to 11am. From the information obtained, it was revealed, that there were no witnesses to the allegation, and staff reported to LPA, they were not working during the alleged incident. LPA was also unsuccessful in obtaining further information from the complainant. It was also reported, that the alleged staff has never had any complaints pertaining to mishandling residents in a rough manner. Therefore, based on interviews, LPA has insufficient evidence to prove the allegation, and it is UNSUBSTANTIATED at this time.

Allegation # 2: Resident was not served an adequate amount of food. On 08/05/2021 and 04/09/2022, from various times, ranging from 12pm to 3pm, LPA conducted interviews with staff.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
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-20210728114416
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: 12/20/2022
NARRATIVE
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During today's visit, LPA conducted additional interviews from 10am to 11am. LPA was also unsuccessful in obtaining further information from the complainant. From the information obtained, it was reported to LPA, that residents are given (3) meals, and (2) snacks a day. The facility has a dietician that creates weekly menus, including snacks, and staff reported to LPA that they follow what is instructed to feed the residents. It was also reported, that all residents are provided additional servings of food if requested. LPA also conducted a food inspection, and it was observed, the facility had an enormous amount of non-perishable and perishable items. LPA also obtained information pertaining to when resident # 1 (R1) goes to bed in the evening. Staff reported R1 is given the privilege to go to bed when R1 wants, and the facility has an incentive plan in place for bedtime. Also it was revealed, that activities are provided to all residents, and R1 enjoys daily bike rides and walks. Therefore, based on interviews, LPA has insufficient evidence to prove, the allegation, and it is UNSUBSTANTIATED at this time.

Exit interview and copy of report provided.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2