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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610464
Report Date: 07/18/2024
Date Signed: 07/18/2024 01:22:48 PM

Substantiated


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
07/10/2024 and conducted by Evaluator Leizl De La Cerra
COMPLAINT CONTROL NUMBER: 31-AS-20240710144210
FACILITY NAME:UNIQUE GROUP HOMEFACILITY NUMBER:
197610464
ADMINISTRATOR:OMOTAYO, BABATUNDEFACILITY TYPE:
735
ADDRESS:8045 GROVE STTELEPHONE:
(818) 770-2940
CITY:SUNLANDSTATE: CAZIP CODE:
91040
CAPACITY:4CENSUS: 0DATE:
07/18/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kenneth Uzoma, CaregiverTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Facility is noncompliant with current approved Program Plan
INVESTIGATION FINDINGS:
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On 7/18/2024, Licensing Program Analysts (LPA) Leizl de la Cerra conducted a initial complaint visit to the facility to investigate the above noted allegation. Department of Mental Health, Assistant Staff Ananlyst Health, Marlon Manalo accompanied LPA with the visit.
LPA's met with Kenneth Uzoma, caregiver and explained the purpose of this visit. Babatunde Omotayo the Licensee/Administrator for the facility was not present at the facility but Kenneth Uzoma contacted Omotayo on the phone. LPA informed Babtunde Omotayo over the phone, the purpose of the visit and Babtunde Omotayo gave consent for Kenneth Uzoma to sign the report.
In reference to the allegation, the concerns were addressed that the facility admitted and retained a client #1 (C1) who was registered under the Department of Mental Health. The admission of the client was out of scope of Program Plan approved by the Community Care Licensing Department (CCLD).
During this investigation a tour of the physical plant was conducted at 10:30. LPA observed no clients in the facility.
Cont. to LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
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 3
Control Number 31-AS-20240710144210
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: UNIQUE GROUP HOME
FACILITY NUMBER: 197610464
VISIT DATE: 07/18/2024
NARRATIVE
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Prior to this visit on 7/15/24 at 5:00PM LPA reviewed the facility program plan approved by CCL. The program plan identifies that the facility will admit the clients with Level 4 developmental disabilities vendorized by Regional Centers.
During this visit, client C1 was no longer in the facility. C1 was relocated by the DMH representative due to improper placement.
Based on inspection, observation, interviews and record review, there is a sufficient information to support the allegation. Therefore, the allegation is substantiated at this time.
Under Title 22 Regulations, the following citation was issued and recorded on LIC9099D.
No other health and safety issues were noted during this visit.
Exit interview was conducted, appeal rights discussed and a copy of report was issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20240710144210
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: UNIQUE GROUP HOME
FACILITY NUMBER: 197610464
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/18/2024
Section Cited
CCR
80022(b)(2)
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80022(b)(2) Plan of Operation (b)The plan and related materials shall contain the following: (2) Statement of admission policies and procedures regarding acceptance of clients.
This requirement is not met as evidenced by:
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On 07/18/2024 LPA observed C1 has been removed. Therefore, the citation was cleared at the time of this visit.
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Licensee retained a client that is not in accordance with the plan of operation. This poses potential health and safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3