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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603436
Report Date: 07/06/2023
Date Signed: 07/06/2023 10:36:10 AM

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
07/05/2023 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230705131131
FACILITY NAME:HIGHPOINTE CARE - FRENCH LANEFACILITY NUMBER:
198603436
ADMINISTRATOR:STEWART, REUBENFACILITY TYPE:
735
ADDRESS:430 FRENCH LN.TELEPHONE:
(562) 682-0946
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY:4CENSUS: 3DATE:
07/06/2023
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Adegboyega Agbelusi/Residential DirectorTIME COMPLETED:
10:50 AM
ALLEGATION(S):
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Facility did not properly evaluate client's care level during pre-admissions.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Irra conducted a visit to investigate the above allegation. LPA met with Adegboyega Agbelusi/Residential Director and discussed the purpose of today's visit.

During today's visit, LPA obtained a staff roster and client face sheets. LPA interviewed Adegboyega Agbelusi/Residential Director, C-1's placement agency and C-1's family member.

Allegation: Facility did not properly evaluate client's care level during pre-admissions. Per interviews conducted, C-1 was properly evaluated and is appropriately placed. Per interviews conducted, there are no concerns with C-1's placement. LPA obtained a copy of C-1's 30-day report which states that C-1 is "happy" at this home and is "gradually getting used to the routine" of this home. LPA also obtained written statements from C-1's placement agency and C-1's family member indicating that this is an approprioate placement for C-1. Interviews and documentation do not corroborate this allegation. ***Refer to LIC 9099C for the continuation of this report***.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023
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-20230705131131
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: HIGHPOINTE CARE - FRENCH LANE
FACILITY NUMBER: 198603436
VISIT DATE: 07/06/2023
NARRATIVE
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Based on record review and interviews conducted the findings indicate, although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview conducted, appeal rights and a copy of this report was provided to Adegboyega Agbelusi/Residential Director
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2