198602858-6-12-2026-28-AS-LHIS-DVBT7V-20260623142922

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602858
Report Date: 06/12/2026
Date Signed: 06/12/2026 05:03:49 PM

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
05/20/2026 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260520091244

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: 3	DATE:	06/12/2026
		UNANNOUNCED	TIME BEGAN:	02:04 PM
MET WITH:	Okey Offor - Direct Support Support Professional II		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff pushed and scratched resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced subsequent complaint visit to investigate the allegation listed above. LPA met with Okey Offor, Direct Support Professional II and explained the purpose of the visit. The administrator, Oluwagbemiro Odofin was called on the phone and the reason for the visit was explained.

The investigation consisted of the following: On 05/28/2026, LPA toured the facility, obtained and reviewed the staff and client rosters, Walnut Sheriff report (#WAL26139-0147, dated 05/19/2026), Staff #1 (S1) files such as training logs, and Client #1 (C1) files pertinent to the investigation. LPA interviewed Staff #2 (S2) and contacted the Service Coordinator (SC) at San Gabriel Pomona Regional Center. Client #1 (C1) was on a home visit therefore was not interviewed.

During today's visit, LPA interviewed Staff #3 (S3) - Staff #4 (S4), Client #2 (C2) and telephonically interviewed Staff #1 (S1). LPA attempted to interview Client #3 (C3) - Client #4 (C4), but unsuccessful due to their cognitive abilities. Client #1 (C1) was still on a home visit therefore was not interviewed. *****CONTINUED ON LIC9099-C*****

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026

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-20260520091244

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: 06/12/2026

NARRATIVE

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The investigation revealed the following:

Allegation: “Staff pushed and scratched resident.” It is alleged that on 05/19/2026 at about 9am, a staff member pushed C1 to the ground and scratched their chest. All staff interviewed denied the allegation stating that they receive regular training on personal rights and zero tolerance policy. S2 stated that S1 was redirecting C1’s behavior on 05/19/2026 and became verbally aggressive and pushed S1. According to S1, there was no physical confrontation and it was C1 who hit them. S2 stated that Walnut Police Dept. responded to a call late in the afternoon on 05/19/2026, but no arrests were made. All staff interviewed stated that C1 has a history of making false allegations and acts aggressively towards staff and other clients. Interviewed client stated that neither S1 nor any of the staff members pushed or scratched them and that all of the staff treat them with respect. There were no witnesses to this incident. Reviewed documents confirmed that C1 has a history of making false allegations and engages in self injurious behaviors. There was no incident report that C1 had been injured. San Gabriel Pomona Regional Center investigated this incident and found the allegation to be unsubstantiated. Therefore there was insufficient evidence to corroborate with the allegation.

Based on statements and interviews conducted with clients and staff 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 was conducted with Oluwagbemiro Odofin, administrator on the phone and a copy of this report was provided to Okey Offor, Direct Support Support Professional II.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026

LIC9099 (FAS) - (06/04)

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