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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881143
Report Date: 11/04/2024
Date Signed: 11/04/2024 12:10:15 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
09/05/2024 and conducted by Evaluator Melody Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240905101105
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: 3DATE:
11/04/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Jennifer IwuTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff is financially abusing client in care.
INVESTIGATION FINDINGS:
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On 11/04/2024 at 09:45 AM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility to deliver the findings of the above allegation. LPA Brown explained the purpose of the visit to staff Jennifer Iwu. Staff Iwu contacted Administrator Olayinka KIng and informed of the visit. The investigation consisted of file review, interviews with staffs and residents as well as observation.

The investigation was conducted by LPA Brown. The investigation consisted of file review and interviews with relevant parties. The allegation indicates that staff is financially abusing client in care. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with three (3) of four (4) clients on 09/12/2024 indicated that there's no staff at the facility that's financially abusing them. Three (3) of four (4) clients interviewed revealed there's no incident that happened at the facility that a staff or Staff #1 (S1) is financially abusing them and they did not hear or witness a staff financially abusing Client #1 (C1). Five (5) of five (5) staff interviewed reported to LPA Brown that ***Continuation in LIC9099***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024
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-20240905101105
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: 11/04/2024
NARRATIVE
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they are not financially abusing their clients at the facility. interviews with five (5) of five (5) staff indicated that there's no incident that happened at the facility that a staff's financially abusing a client. Five (5) of five staff interviewed revealed that there's no staff at the facility that's financially abusing C1 and they are not aware of an incident that S1 financially abused C1. Per documents review, LPA Brown observed documentation that C1 was receiving Social Security benefits check previously was later updated to receiving Social Social benefits via debit card.

Moreover, interview with C1 Inland Regional Center (IRC) Consumer Services Coordinator (CSC) indicated that C1 contacted Social Security and requested that C1 will be C1's payee and to receive C1's benefits via debit card and not Social Security Checks. C1 IRC CSC reported that when C1 received the debit card from Social Security, C1 reported it to the staffs at the facility and they instructed C1 to put back the debit card received in the mail. C1 was able to obtain a copy of the debit card issued by Social Security and made purchases on the card and sent it to C1's girlfriend as birthday gifts. C! IRC CSC added that when C1 and facility staff went to the bank to withdraw C1's Personal & Incidental (P&I) and C1's rent, and staff obtained information that there's missing funds in C1's account, C1 accused the facility of financially abusing C1 and C1 refused to pay rent at the facility. IRC CSC informed LPA Brown that it was C1 that's financially abusing the facility as C1 refused to pay rent for two (2) months now.

Based on the evidence, the allegation that staff is financially abusing client in care 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 staff Jennifer Iwu..
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2