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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880820
Report Date: 11/21/2022
Date Signed: 11/21/2022 11:02:50 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/14/2022 and conducted by Evaluator Ryan Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20221114153256
FACILITY NAME:YEMMA CARE HOME INCORPORATIONFACILITY NUMBER:
331880820
ADMINISTRATOR:OYEBOBOLA, OLAYEMIFACILITY TYPE:
735
ADDRESS:24507 POINSETTIA DRIVETELEPHONE:
(818) 213-8485
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92532
CAPACITY:4CENSUS: 3DATE:
11/21/2022
UNANNOUNCEDTIME BEGAN:
08:47 AM
MET WITH:Emmanuel Oyebobola- House ManagerTIME COMPLETED:
11:13 AM
ALLEGATION(S):
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Client obtained unexplained bruising while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ryan Gardner conducted an unannounced visit to the facility for the purpose of initiating an investigation and delivering findings for the above complaint allegation. LPA met with House Manager Emmanuel Oyebobola and explained the reason for the visit.

During today’s visit, LPA toured the facility, reviewed and requested facility documents, interviewed staff members, and interviewed clients.

For allegation, Client obtained unexplained bruising while in care:

LPA interviewed three (3) clients and three (3) staff, during interviews conducted there was no indication that the client was injured by another person. The facility sent State Licensing a Special Incident Report (SIR) on 11/17/22, the SIR states that on 11/11/2022 a client was moving furniture out of a bedroom and bruising appeared the following day on 11/12/2022. During interviews conducted with clients and staff, LPA found that furniture was being moved out of a bedroom by the client on 11/11/2022.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022
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 56-AS-20221114153256
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: YEMMA CARE HOME INCORPORATION
FACILITY NUMBER: 331880820
VISIT DATE: 11/21/2022
NARRATIVE
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Based on the information found during the investigation, the allegation listed above is deemed UNSUBSTANTIATED.

A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation listed above is deemed unsubstantiated.

During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report was discussed and provided to House Manager Emmanuel Oyebobola, along with a copy of the appeal rights.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2