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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603616
Report Date: 11/01/2024
Date Signed: 11/01/2024 12:05:50 PM

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
06/07/2024 and conducted by Evaluator Erik Zaragoza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240607135753
FACILITY NAME:OLUWATOYIN HOME2, LLCFACILITY NUMBER:
198603616
ADMINISTRATOR:OSIBOGUN, OLAIDEFACILITY TYPE:
735
ADDRESS:155 W RENWICK RDTELEPHONE:
(626) 804-3418
CITY:AZUSASTATE: CAZIP CODE:
91702
CAPACITY:4CENSUS: 4DATE:
11/01/2024
UNANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:Silverline Amadi - Direct Support StaffTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Staff did not provide adequate supervision resulting in resident being threaten by another resident in care.
Staff yells at resident in care.
Staff did not ensure resident medical equipment was in good working condition.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Erik Zaragoza and Mayra Cota conducted a subsequent complaint visit to investigate the allegations listed above. LPAs met with Silverline Amadi, Direct Support Staff for the facility, and explained the purpose of the visit. Administrator Olaide Osibogun arrived shortly thereafter.

The investigation consisted of the following: During the initial visit conducted on 6/11/2024, LPA Nune Margaryan LPA obtained a copies of the Client Roster and Staff Roster, Review and obtained relevant copies of Client #1's (C1’s) file, conducted interviews with Staff #1 - 4 (S1 - S4), and Client #2 (C2). C1 was not interviewed because on 05/31/24 was hospitalized and didn't returned back to the facility. During today's visit on 11/1/2024, LPAs Erik Zaragoza and Mayra Cota interviewed Clients #3 - 4 (C3 - C4), reviewed the Individual Program Plan (IPPs) for C1, C3 and C4, and interviewed Witness #1 (W1). LPAs attempted to interview C1, however C1 has since moved out of the facility and their whereabouts are unknown.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024
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-20240607135753
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: OLUWATOYIN HOME2, LLC
FACILITY NUMBER: 198603616
VISIT DATE: 11/01/2024
NARRATIVE
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In regards to the allegation that "Staff did not provide adequate supervision resulting in resident being threaten by another resident in care," it is alleged that C2 had been threatening C1 in the facility, and that staff took no action to prevent the harassment. During interviews with the clients, three (3) out of three (3) could not corroborate the allegation. One of the clients interviews stated C2 has never yelled at any of the other clients in the facility. Another client interviewed stated that no clients have ever threatened one another in the facility. During interviews with the staff, four (4) out of four (4) did not corroborate the allegation. One of the staff interviewed stated that they have never noticed C2 threatening C1 or any of the other clients in the facility. Another staff stated that C2 has never been confrontational with C1.

In regards to the allegation that "Staff yells at resident in care," it is alleged that S1 has yelled at C1 in the facility. During the investigation, two (2) out of three (3) clients did not corroborate the allegation that clients have been yelled at by staff. One client interviewed stated that S1 has never raised their voice at them or any of the other clients in the facility. Another client interviewed stated that they have never noticed S1 or any of the other staff yelling at clients in the facility. During interviews with staff, four (4) out of four (4) did not corroborate the allegation. One of the staff interviewed stated that in a recent incident, C1 had become upset after S1 had asked them to throw away certain items in their room, which upset C1, however S1 did not raise their voice at them and C1 later apologized. Another staff interviewed stated that they have never seen S1 yell at C1, and that none of the staff in the facility raise their voice at the clients.

In regards to the allegation that "Staff did not ensure resident medical equipment was in good working condition," it is alleged that repairs were required on C1's Continuous Positive Airway Pressure (CPAP) machine, however for a stretch of time the repairs were not made and C1 was not able to use the machine. During interviews with the clients, three (3) out of three (3) did not corroborate the allegation. One of the clients interviewed stated that they saw that C1 always had the CPAP machine in their room. Another client interviewed stated that from what she saw, C1 always had access to her CPAP machine that was located in her room. During interviews with the staff, four (4) out of four (4) did not corroborate the allegation. One of the staff interviewed explained that C1 had a sleep study in March of 2024, where it was determined that they required a different setting for their CPAP machine, and therefore had a subsequent advanced sleep study conducted in May of 2024, where it was determined that new settings were required for the machine.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20240607135753
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: OLUWATOYIN HOME2, LLC
FACILITY NUMBER: 198603616
VISIT DATE: 11/01/2024
NARRATIVE
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During C1's hospital stay, a hospital technician ordered a loaner CPAP machine for C1. The staff later explained that the Durable Medical Equipment (DME) company that was to provide the loaner CPAP machine stated that they would deliver the CPAP machine once C1 returned to the facility, however C1 was instead transferred to another facility. The staff stated that they provided the order for the loaner CPAP machine to the new facility administrator (W1) so that they can contact the DME company so they can obtain the machine for C1 once they arrive at their facility. LPAs called W1 over the phone, and W1 confirmed that she did received the order from the staff at Oluwatoyin Home2, and that they were able to order the CPAP machine for C1. LPAs were also provided documentation for the loaner CPAP machine from the administrator.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. 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 allegations are UNSUBSTANTIATED.

Exit interview held, and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3