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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006074
Report Date: 09/05/2025
Date Signed: 11/25/2025 05:06:26 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/27/2025 and conducted by Evaluator Eboni Bentley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250827093731
FACILITY NAME:SUCCESSFUL PEOPLE LLC #5FACILITY NUMBER:
306006074
ADMINISTRATOR:SNODDY, FRANCESFACILITY TYPE:
735
ADDRESS:1774 W CHALET AVETELEPHONE:
(310) 902-4893
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:4CENSUS: 2DATE:
09/05/2025
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Adrianna Harbin - AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Clients were not accorded with a safe and healthful environment.
INVESTIGATION FINDINGS:
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THIS IS AN AMENDED REPORT

On September 5, 2025, Licensing Program Analyst (LPA) Eboni Bentley conducted a 10-day complaint visit to investigate the above allegations. LPA met with Direct Support Staff (DSP) Kehinde Tayese and LPA was granted entry into the facility. The DSP contacted Administrator (AD) Adrianna Harbin by telephone and placed call on speaker phone. LPA stated the reason for the visit and began tour with DSP Tayese. AD arrived a short time later and remained throughout the visit to assist with the investigation. LPA observed two clients present and one Direct Support Staff on duty.

The investigation consisted of the following: A tour of the indoor and outdoor grounds of the facility, interviews and record review of the following documents for two clients including facility records: client/staff rosters, Personnel Record (LIC500), Personnel Report Summary, Client Face Sheets, Physician’s Reports, Quarterly Progress Evaluations, and Therapy Logs for August 2024 Client #1 (C1).
Report continued on LIC 9099-C…..
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2025
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 2
Control Number 22-AS-20250827093731
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: SUCCESSFUL PEOPLE LLC #5
FACILITY NUMBER: 306006074
VISIT DATE: 09/05/2025
NARRATIVE
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Regarding the allegation: Clients were not accorded with a safe and healthful environment

LPA observed no imminent health and safety issues. There were no signs of any cigarette/marijuana butts in the back yard area or on physical plant. The facility does not have a designated smoking area. There are currently two clients in care. One out of two clients in care indicated not witnessing any smoking marijuana recently or during the time of the alleged incident. Eight out of eight current and former staff interviewed denied the allegation. Six of those staff, reported working at the facility during August 2024, and two new employees denied witnessing anyone smoking marijuana at the facility.

Based on the observations made, interviews conducted, and the records that were reviewed, 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 both allegations are deemed UNSUBSTANTIATED.

Administrator Adrianna Harbin authorized Lead Direct Support Staff Hasayn Bailey Jr to sign on her behalf.
An exit interview was conducted with Lead Direct Support Staff Hasayn Bailey Jr and a copy of this report was provided at the end of the visit.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2