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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603658
Report Date: 07/02/2024
Date Signed: 07/02/2024 02:40:38 PM

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
06/24/2024 and conducted by Evaluator Bonnie Tao
COMPLAINT CONTROL NUMBER: 28-AS-20240624170502
FACILITY NAME:DIGNITY HOME CENTER INCFACILITY NUMBER:
198603658
ADMINISTRATOR:DUROMOLA, ADEBOWALE EVELYNFACILITY TYPE:
735
ADDRESS:230 E BENWOOD STTELEPHONE:
(626) 922-3944
CITY:COVINASTATE: CAZIP CODE:
91722
CAPACITY:6CENSUS: 6DATE:
07/02/2024
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Adebowale Evelyn Duromola, administratorTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Facility failed to report missing client within a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tao conducted an Initial 10-Day complaint investigation regarding the above allegations. LPA discussed the purpose of the visit with Evelyn Duromola, administrator.

Investigation consisted of the following: interview of administrator (staff#1); interviews of clients from client#2 (C2) through client #3 (C3); reviewed client#1 (C1) record reviews, and a facility tour. LPA obtained copies of the staff and client rosters; and client files for client #1 (C1) with relevant information.

The investigation revealed the following:
For the allegation of facility failed to report missing client within a timely manner, it was alleged that administrator did not report client’s absence without leave (AWOL) to licensing agencies.

(-continued in LIC 9099 C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
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 2
Control Number 28-AS-20240624170502
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: DIGNITY HOME CENTER INC
FACILITY NUMBER: 198603658
VISIT DATE: 07/02/2024
NARRATIVE
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Per client interviews, all two (2) clients could not corroborate the allegation. Per staff interview, administrator denied the allegation. Staff interview revealed that it was client#1's own wish to leave the facility going to client's friend house on January 20, 2024. The administrator reported the incident to licensing. File review revealed administrator reported C1’s AWOL to licensing on January 21, 2024. Thus, the facility did not fail to report missing client within a timely manner.

Based on the information obtained during the investigation, interviews with staff, clients, review of client files and LPA's observation, the investigation did not reveal any evidence to support the allegations mentioned above.

Although the allegations may have happened or are valid, there is not preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegation is UNSUBSTANTIATED.

Exit interview conducted with Evelyn, administrator. A copy of this report were provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2