198602858-1-30-2026-28-AS-LHIS-DQXSCZ-20260203124622

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602858
Report Date: 01/30/2026
Date Signed: 01/30/2026 11:32:40 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
05/30/2025 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250530104712

FACILITY NAME:	KOKUMAH EVERYDAY GRACE ONE INCORPORATION		FACILITY NUMBER:	198602858
ADMINISTRATOR:	OLUWAGBEMIRO ODOFIN		FACILITY TYPE:	735
ADDRESS:	21236 FIBRE COURT		TELEPHONE:	(818) 448-3012
CITY:	WALNUT	STATE: CA	ZIP CODE:	91789
CAPACITY:	4	CENSUS: 4	DATE:	01/30/2026
		UNANNOUNCED	TIME BEGAN:	09:56 AM
MET WITH:	Oluwagbemiro Odofin - Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility staff hit client in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted a subsequent complaint visit to deliver findings for the above-mentioned allegation. Upon arrival, administrator Oluwagbemiro Odofin was called on the phone as no one answered the door. LPA met with the administrator who arrived at 10:40am and explained the purpose of the visit.

The investigation consisted of the following: On 06/03/2025, LPA conducted a tour of the physical plant, obtained copies of the Client & Staff Rosters, Incident reports (SIRs) (May 2025) involving C1 and Police reports (05/28/2025 & 05/29/2025). LPA also obtained copies of Client #1 (C1) files relevant to the investigation. LPA interviewed (5) staff and (2) clients. LPA also obtained additional documents pertinent to the investigation prior to today’s visit.

During today’s visit, LPA toured the facility, obtained copies of the Client & Staff Roster and delivered findings.*****CONTINUED ON LIC9099-C*****

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250530104712

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: KOKUMAH EVERYDAY GRACE ONE INCORPORATION	FACILITY NUMBER: 198602858
	VISIT DATE: 01/30/2026

NARRATIVE

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The investigation revealed the following:

Regarding the allegation: “Facility staff hit client in care.” It is alleged that on the evening of 05/28/2025, C1 was opening a window in C1’s bedroom, when S5 got upset and punched C1 in the eyes and stomach, resulting in bruises. Staff interviewed denied the allegation stating they receive regular training on personal rights and zero tolerance policy. S5 stated that on the evening of 05/28/2025, S5 asked C1 to close the window for safety reasons but C1 did not like to be redirected and became verbally aggressive, S5 stated there was no physical confrontation and S5 did not call the police. Nonetheless, a police officer arrived later that evening in response to a call from C1 but there were no arrests. And when asked by the police, C1 declined medical care (LPA obtained a copy of this police report dated 05/28/2025). The next day, 05/29/2025, San Gabriel Pomona Regional Center contacted the Walnut Sheriff Department, who arrived at the facility and spoke with C1, but no arrests nor additional information provided. Some staff interviewed stated that C1 makes false allegations and acts aggressively towards staff and other clients. Interviewed client stated they were never hit by staff and the staff treat them with respect. C1 provided an audio recording and photos, but these suggested possible self-inflicted injuries. Furthermore, it could also be heard on the audio recording that C1 was being disruptive. There were no other witnesses to this incident. Based on LPA’s observation during the visit on 06/03/2025, there were no visible injuries on C1’s face, and C1’s glasses did not appear to be damaged. Per record review, C1 has a history of making false allegations and engages in self injurious behaviors. San Gabriel Pomona Regional Center investigated this incident and found the allegation to be unsubstantiated.

Based on LPA's observations, statements and interviews conducted, as well as reviewed files and documentation, there was not enough supportive evidence to corroborate the 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 conducted and a copy of this report was provided to Oluwagbemiro Odofin, Administrator.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026

LIC9099 (FAS) - (06/04)

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