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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881143
Report Date: 09/12/2024
Date Signed: 09/12/2024 04:04:12 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
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/10/2024 and conducted by Evaluator Melody Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240910105058
FACILITY NAME:DIVINE RESIDENTIAL INCFACILITY NUMBER:
331881143
ADMINISTRATOR:AKINMULERO, BOLAJIFACILITY TYPE:
735
ADDRESS:31500 SAGECREST DRIVETELEPHONE:
(951) 409-3703
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92532
CAPACITY:4CENSUS: 4DATE:
09/12/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Assistant Administrator Olayinka KingTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Staff hit client.
INVESTIGATION FINDINGS:
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On 09/12/2024 at 12:00 PM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility to initiate a complaint investigation and deliver the findings of the above allegation. LPA Brown explained the purpose of the visit to a staff and was granted entry at the home. Staff contacted Licensee Bolaji Akinmulero and informed of the visit and Licensee Akinmulero arrived during the visit. Assistant Administrator Olayinka King was contacted and informed of the visit and arrived during the visit.The investigation consisted of file review, interviews with staff and clients as well as observation.

The investigation was conducted by LPA Melody Brown. The investigation consisted of observation and interviews with relevant parties. The allegation indicates that staff hit clients. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with three (3) of four (4) clients indicated that they did not witness a staff hitting a client at the facility. Interviews with four (4) of four (4) staffs indicated that no staff at the facility hits a client. Interviews with four (4) of four (4) staffs
***Continuation in LIC9099C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024
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 56-AS-20240910105058
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: DIVINE RESIDENTIAL INC
FACILITY NUMBER: 331881143
VISIT DATE: 09/12/2024
NARRATIVE
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revealed that there's no incident that a staff at the facility hit a client in care. During the visit today, 09/12/2024, LPA Brown observed staffs at the facility are providing care and supervision to their clients. Also, LPA Brown observed staffs at the facility are communicating, socializing and checking on all their clients.

Based on the evidence, the allegation that Staff hit client is 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 is unsubstantiated at this time.

An exit interview was conducted where this report, LIC9099 was discussed and provided to Assistant Administrator Olayinka King.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2