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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600085
Report Date: 09/07/2021
Date Signed: 09/07/2021 01:25:46 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/30/2021 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20210830093430
FACILITY NAME:CHOICES R US - WOODHUEFACILITY NUMBER:
198600085
ADMINISTRATOR:BRADFORD, SHAJUANAFACILITY TYPE:
735
ADDRESS:9523 WOODHUE STTELEPHONE:
(562) 942-1419
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY:6CENSUS: 6DATE:
09/07/2021
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Administrator Adeshola ObayoTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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Facility phone is not accessible to clients.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint visit regarding the above allegation. LPA met with Staff and Administrator Adeshola Obayo arrived shortly after. The purpose of the visit was discussed.

The investigation consisted of the following: LPA obtained copies of Staff roster and client facesheets. LPA also toured the facility. LPA also interviewed Staff #1-#3 (S1-S3) and Clients #1 - Client #5 (C1-C5). Client #6 was away at day program at the time of the visit.

The investigation revealed the following: in regards to the allegation "Facility phone is not accessible to clients." it was alleged that facility staff kept the facility phone locked in a cabinet inaccessible to clients. (3) of (3) staff interviewed collaborated the allegation. (3) of (5) clients interviewed collaborated the allegation. Interviews showed that the facility staff had been keeping the phone locked in the cabinet due to previous issues with clients making non-emergency calls to 911 and random companies.

Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021
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 5
Control Number 28-AS-20210830093430
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CHOICES R US - WOODHUE
FACILITY NUMBER: 198600085
VISIT DATE: 09/07/2021
NARRATIVE
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Clients stated that they had to ask staff for permission to access the facility phone when they needed to make calls. LPA was informed that on 8/30/21 Regional center staff arrived and witnessed the phone locked in a cabinet. Based on LPA's interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be Substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D.

Exit Interview was conducted with Administrator Adeshola Obayo and a hardcopy was provided via email for signature. Appeal Rights given and discussed.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20210830093430
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CHOICES R US - WOODHUE
FACILITY NUMBER: 198600085
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/17/2021
Section Cited
CCR
85702(b)(9)
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85072 Personal Rights (b) The licensee shall insure that each client is accorded the following personal rights.(9) To have access to telephones in order to make and receive confidential calls, provided that such calls do not infringe upon the rights of other clients and do not restrict availability of the telephone during emergencies.
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Deficiency was corrected by the time of the visit. Regional Center staff addressed the issue on 8/30/21 with administrator. Facility phone is no longer inaccessible to clients.
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This requirement was not met as evidence by the following: LPA was informed that staff kept the the facility phone locked and inaccessible to clients. This poses a potential health and safety risk to clients under care and supervision.
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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.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/07/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/30/2021 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20210830093430

FACILITY NAME:CHOICES R US - WOODHUEFACILITY NUMBER:
198600085
ADMINISTRATOR:BRADFORD, SHAJUANAFACILITY TYPE:
735
ADDRESS:9523 WOODHUE STTELEPHONE:
(562) 942-1419
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY:6CENSUS: 6DATE:
09/07/2021
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Administrator Adeshola ObayoTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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Facility is not meeting staff to client ratios
Facility does not have adequate food supplies on hand.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint visit regarding the above allegation. LPA met with Staff and Administrator Adeshola Obayo arrived shortly after. The purpose of the visit was discussed.

The investigation consisted of the following: LPA obtained copies of Staff roster and client facesheets. LPA also toured the facility. LPA also interviewed Staff #1-#3 (S1-S3) and Clients #1 - Client #5 (C1-C5). Client #6 was away at day program at the time of the visit.

The investigation revealed the following: in regards to the allegation "Facility is not meeting staff to client ratios ." it was alleged that on 8/17/21 there had only been 1 staff present for all 6 clients of the facility. (5) of (5) clients interviewed could not corroborate the allegation. LPA reviewed the facility staff schedule and observed that staffing was sufficient throughout. LPA received an incident report for that day stating C1 had a behavior issue but there were 2 staff present.

Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20210830093430
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CHOICES R US - WOODHUE
FACILITY NUMBER: 198600085
VISIT DATE: 09/07/2021
NARRATIVE
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Review of client files shows that (1) of (6) clients requires a 1-on-1 staff for 8 hours of the day only. 2 staff on site meets the minimum requirements when there are 6 clients and 1-on-1 services are not currently being provided. Based on statements and interviews conducted with clients and staff as well as LPAs file reviews and observations, there was not enough supportive evidence to concur with the reported allegation.

In regards to allegation. "Facility does not have adequate food supplies on hand" it was alleged that the facility did not have enough food on site for all clients. (3) of (3) staff interviewed denied the allegation. (5) of (5) clients interviewed could not corroborate the allegation. LPA observed the food supply of the facility to have the required 7 day minimum of non perishables and fresh perishable foods for a minimum of two days. The food supply currently on site matched with the food menu provided by the facility. Interviews stated that staff purchase groceries every Monday but have now started going out on Thursdays as well if needed. Based on interviews conducted with clients and staff as well as LPAs file reviews and observations, there was not enough supportive evidence to concur with the reported allegation.

Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore all the allegations are UNSUBSTANTIATED.

An exit interview was conducted with Administrator Adeshola Obayo and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5