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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600625
Report Date: 01/23/2025
Date Signed: 01/23/2025 12:53:09 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
01/16/2025 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250116085332
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:
01/23/2025
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Administrator Akinwale Victor OrunesajoTIME COMPLETED:
01:05 PM
ALLEGATION(S):
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Staff did not ensure facility is free of pests
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint investigation visit for the allegation listed above. LPA met with administrator Akinwale Victor Orunesajo and the purpose of the visit was discussed.

LPA conducted the following: LPA interviewed Staff #1-2 (S1-S2) , interviewed Client #1-4 (C1-C4) , collected copies of the staff and client rosters, collected the facesheets of C1-C4, and reviewed documents of pest control for the facility. LPA also interviewed clients placement agency and C1's day program (W1-W2). The investigation revealed the following:

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: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025
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 28-AS-20250116085332
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: VICTORIOUS RESIDENTIAL HOME
FACILITY NUMBER: 198600625
VISIT DATE: 01/23/2025
NARRATIVE
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In regards to the allegation "Staff did not ensure facility is free of pests" it is alleged that the facility has roaches and the roaches have been observed in clients personal belongings. (2) of (2) Staff interviewed denied the allegation. (3) of (4) Clients interviewed could not corroborate the allegation. Further information provided stated that C1 was observed to have roaches on their personal belongings when attending their day program on 1/13/25 and again on 1/14/25. LPA interviewed C1 who corroborated having roaches on their person as well as their personal items. C1 confirmed to have seen roaches in their home. File review shows record from C1's day program reporting roaches observed on C1's person for the dates of 1/13/25 and 1/14/25. File review shows the facility contracted an extermination company on 1/22/25 where roaches were noted to be in the facility. There is no documentation of pest control services prior to that date. During the tour of the home, LPA observed dying roaches throughout the facility. This shows the staff did not ensure the facility to be free of pests prior to 1/22/25 when pest control was contacted.

Based on LPA’s interviews, observations and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiency cited on the attached LIC 9099D.

An exit interview was conducted, and a copy of this report was provided to Administrator Akinwale Victor Orunesajo. Appeal rights also provided and discussed.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250116085332
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: VICTORIOUS RESIDENTIAL HOME
FACILITY NUMBER: 198600625
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/06/2025
Section Cited
CCR
80087(a)(1)
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80087 Buildings and Grounds. (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.
(1) The licensee shall take measures to keep the facility free of flies and other insects.
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POC is cleared at the time of this visit.

Administrator contacted pest control services that started on 1/22/25.
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This was not met as evidenced by: roaches to be observed in the facility prior to exterminator being contacted on 1/22/25. LPA observed dying roaches during the visit as well. This poses a 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.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3