198603616-9-18-2025-28-AS-WSHO-DM4U3B-20251003151315

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603616
Report Date: 09/18/2025
Date Signed: 09/18/2025 11:07:56 AM

Unsubstantiated

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
02/25/2025 and conducted by Evaluator Nune Margaryan

COMPLAINT CONTROL NUMBER: 28-AS-20250225121117

FACILITY NAME:	OLUWATOYIN HOME2, LLC		FACILITY NUMBER:	198603616
ADMINISTRATOR:	OSIBOGUN, OLAIDE		FACILITY TYPE:	735
ADDRESS:	155 W RENWICK RD		TELEPHONE:	(626) 804-3418
CITY:	AZUSA	STATE: CA	ZIP CODE:	91702
CAPACITY:	4	CENSUS: 4	DATE:	09/18/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Silverline Amadi		TIME COMPLETED:	11:10 AM

ALLEGATION(S):

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Questionable Death

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nune Margaryan conducted a subsequent unannounced complaint visit to deliver finding to the above mentioned allegation. LPA met with staff. Administrator arrived shortly after and assisted with visit. Reason for the visit was explained.

The investigation consisted of the following: On 02/27/25 LPA obtained copies of Staff & Client rosters, interviewed Administrator, Staff (S1) and Staff 2 (S2) and requested Client 1’s (C1) file. LPA reviewed and collected documents related to C1. The facility tour was conducted; no health and safety concerns were observed. Quality Assurance Specialist from SGPRC was interviewed over the phone.

Continue 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025

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-20250225121117

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: OLUWATOYIN HOME2, LLC	FACILITY NUMBER: 198603616
	VISIT DATE: 09/18/2025

NARRATIVE

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Regarding allegation: Questionable Death. It was alleged that the client was not aided with proper lifesaving actions and passed away as a result.

C1 passed away on 2/16/25. Interviews were conducted with Administrator, staff and Regional Center staff. Records were also reviewed including paramedic’s / EMS report and coroner's report / Death certificate. Interviewed Administrator and staff stated, on 02/16/25 after C1 ate their breakfast in the morning, after a while C1 went to the kitchen and brought out bread and peanut butter. Staff assisted C1 and C1 was eating their sandwich at about 11:52am. Per C1’s IPP C1 chooses what they would like to eat for breakfast and lunch and staff will assist with meal preparations (Per C1’s IPP and Health Report C1 has been eating a lot and does not know when to stop). Interviewed Administrator stated whenever C1 was eating, staff were always with her by the table to remind her to slow down, finish what is in her mouth before taking another bite. Per C1’s file review, C1 did not have a history of choking but was known to be a rapid eater and documentation states C1 eats independently and feeds herself. While eating the sandwich C1 was redirected several times to slow down when eating. S1 and S2 who were sitting around the table with C1 noticed C1 was choking. S1 quickly gave C1 abdominal thrusts while S2 called 911. C1 spit a little out and still wanted to pick the remaining sandwich, but staff told her to leave it. Paramedics came in at about 11:57am. S1 was still doing the abdominal thrust when the paramedics came, S1 was told to step aside, and they took over. They were able to suction some food out. After noticing that C1's oxygen saturation is getting low, they gave oxygen to C1 and took C1 to the hospital at about 12:20pm. S2 was with C1 in the ambulance on the way to the hospital. Medical / paramedics reports indicate "C1 was choking on a PB&J sandwich and became cyanotic. EMS was called and were able to dislodge some of the food. After the oxygen level was getting low, EMS took C1 in the ambulance to the hospital". S2 stated that medical staff was performing CPR on C1 in the ambulance and in the hospital. Administrator who had already arrived at the hospital was informed that C1 had passed away.

Continue 9099C

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20250225121117

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: OLUWATOYIN HOME2, LLC	FACILITY NUMBER: 198603616
	VISIT DATE: 09/18/2025

NARRATIVE

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Interviewed QA stated that Investigation showed that Facility staff took all reasonable steps to help C1; performed Heimlich Maneuver and 911 was called for assistance. C1 was taken to the hospital then pronounced deceased at Inter Community Hospital. Police Officer, Austria Cardinez came to the facility on 02/25/25 at about 6pm. The officer reviewed facility files and confirmed that all staff are First Aid & CPR certified. He left the facility without giving any report or case number. The police did not conduct an investigation. Interviews and files review revealed that proper lifesaving actions were administered by staff and paramedics and C1 was taken to the hospital where C1 received emergency care but passed later at the hospital. Interviews and files review does not corroborate this allegation. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated.

Exit interview held, and a copy of this report was provided.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025

LIC9099 (FAS) - (06/04)

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