331881143-10-27-2021-18-AS-EMAN-C9AU7L-20211201142003

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881143
Report Date: 10/27/2021
Date Signed: 10/27/2021 01:05:51 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, 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
10/11/2021 and conducted by Evaluator Jennifer Semin

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20211011090841

FACILITY NAME:	DIVINE RESIDENTIAL INC		FACILITY NUMBER:	331881143
ADMINISTRATOR:	AKINMULERO, BOLAJI		FACILITY TYPE:	735
ADDRESS:	31500 SAGECREST DRIVE		TELEPHONE:	(951) 409-3703
CITY:	LAKE ELSINORE	STATE: CA	ZIP CODE:	92532
CAPACITY:	4	CENSUS: 3	DATE:	10/27/2021
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Boladele Ige		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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9

Resident was physically abused while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jennifer Semin conducted an unannounced visit to deliver the findings for the above complaint allegation. LPA met with House Manager, Boladele Ige.
The investigation consisted of interviews and review of records. The allegation, Resident was physically abused while in care. Staff stated they did not physically abuse any clients in care. Staff stated that Client 1 (C1) had been physically abusive towards staff. C1 stated staff were never physically abusive, never touched C1 or never yelled at C1 at the facility.
Based upon interviews and information gathered, and 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 is UNSUBSTANTIATED at this time.
An exit interview was conducted where this report was discussed and provided to Ms. Ige.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Jennifer Semin
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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