<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600625
Report Date: 04/17/2023
Date Signed: 04/17/2023 02:48:21 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
04/13/2023 and conducted by Evaluator Alma Gonzalez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230413090818
FACILITY NAME:VICTORIOUS RESIDENTIAL HOMEFACILITY NUMBER:
198600625
ADMINISTRATOR:ORUNESAJO, AKINWALE VICTORFACILITY TYPE:
735
ADDRESS:411 GARDA AVENUETELEPHONE:
(818) 448-3012
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY:4CENSUS: 4DATE:
04/17/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Akinwale OrunesajoTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained unexplained injuries while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with Administrator Akinwale Orunesajo and explained the reason for the visit.

The investigation consisted of: LPA conducted interviews with Administrator Akinwale Orunesajo, Staff 1-2, and Client 1-4 (C1-4). LPA additionally conducted telephone interviews with San Gabriel Pomona Regional Center (SGPRC) Service Coordinator (SC) Edzle Agabao, Witness 1 (W1) and attempted phone calls to SGPRC Quality Assurance (QA) Marilyn Garcia and W2. LPA obtained copies of Staff and Client Rosters. LPA reviewed C1's file and collected copies of documents relevant to the investigation.



(See LIC9099C for continuation)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
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 28-AS-20230413090818
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: VICTORIOUS RESIDENTIAL HOME
FACILITY NUMBER: 198600625
VISIT DATE: 04/17/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Investigation revealed the following: Regarding allegation, Resident sustained unexplained injuries while in care, it is alleged that a facility client was observed to have lesions and scratches on hands and upper arm and when asked how and where they acquired the injuries the client pointed to a picture of a facility staff. Client additionally pointed to their mouth and gestured with a fist towards the mouth area while also saying "ow". Client was also allegedly hit on the head and stated that the staff that hit them is "mommy'. Interview with Administrator Orunesajo and S1-2 revealed that all facility staff treat all clients with dignity and respect and staff have never physically or verbally abused any client in care. They denied that any facility staff caused any facility client to have unexplained injuries while in care. Administrator and S1-2 stated that C1 has self-injurious behavior. C1 will scratch themselves, dig in their skin, bang their head and also grind their teeth. Administrator and S1-2 also stated that C1 calls all female staff "mommy". Administrator stated that a LASD Industry deputy visited the facility on 4/12/23 and again on 4/15/23 and stated that the deputy spoke to C1. A report number was only left on 4/15/23. Administrator stated SGPRC QA also visited the facility on 4/12/23 and showed a picture to administrator of a female staff that C1 had alleged was the perpetrator. Administrator stated that he reported to SGPRC QA that the staff in the picture was a previous staff and had not been a staff of the facility since April 2022. Interview conducted with SGPRC SC revealed that their investigation did not reveal anything of concern and provided QA's contact information as they had additional information. Interviews conducted with 4 out of 4 facility clients revealed that facility staff have never physically hurt them, staff are nice and take good care of them and they are happy. Interview with C1 revealed that staff have not hurt them and they like the staff and also like living at the facility. C1 also referred to female staff as "mommy". C1 showed LPA their album and every female in the album was referred to as "mommy", males as "daddy" an infant as "baby" and so on. C1 was able to state other clients names while pointing at them in pictures. .

During the time of the visit, LPA observed clients having their snacks and in the living room watching television and did not observe anything of concern. LPA observed facility staff tending to the clients and assisting them and did not observe anything of concern with staff and client interactions. LPA did not observe any scratches on C1 or any bruising on face. Based on statements gathered from interviews conducted with staff, Regional Center staff, facility clients and LPA observations, there was not enough supportive evidence to concur with the reported allegation.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview held. A copy of the report was provided to Administrator Orunesajo.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2