331881143-12-27-2024-56-AS-EMAN-DDAL25-20250126072147

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881143
Report Date: 12/27/2024
Date Signed: 12/27/2024 02:15:56 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
10/29/2024 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20241029093043

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:	12/27/2024
		UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Jennifer Iwu		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Facility staff did not prevent physical altercation between clients.
Facility staff did not provide food in the quantity necessary.

INVESTIGATION FINDINGS:

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On 12/27/2024 at 01:05 PM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility to deliver the findings of the above allegations. LPA Brown was greeted and granted entry by a staff and LPA Brown explained the purpose of the visit. Staff contacted Administrator Olayinka King and informed of the visit. The investigation consisted of file review, interviews with staff and clients as well as observation.

The investigation was conducted by LPA Brown. The investigation consisted of file review and interviews with relevant parties. The first allegation indicates facility staff did not prevent physical altercation between clients. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with four (4) of four (4) clients indicated that staff at the facility are preventing physical altercation between clients. Client #1 (C1) reported to LPA Brown that staffs at the facility are supervising them, and they are preventing physical altercation between clients. C1 added that during the incident on 10/22/2024, Client #2 (C2) punched C1 in the eye and it all happened so fast. **Cont. on LIC9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2024

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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Control Number 56-AS-20241029093043

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: 12/27/2024

NARRATIVE

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Interview with three (3) of three (3) staff indicated that they are supervising their clients, and they are monitoring them to make sure that they can redirect their clients to prevent physical altercation between them. During the facility visit on 11/04/2024, 12/04/2024 and 12/05/2024 LPA Brown observed two (2) staffs working at the facility and providing care and supervision to their clients.

The second allegation indicates facility staff did not provide food in the quantity necessary. Interviews with four (4) of four (4) clients indicated that staff at the facility are providing sufficient quantity of food. Four (4) of four (4) clients interviewed stated that they can get second servings if they want more food. Four (4) of four (4) clients reported to LPA Brown that they have plenty of food at the facility and there's no incident that staff at the facility did not provide food in the quantity necessary. Interviews with three (3) of three (3) staffs indicated that they always provide food in the quantity necessary for their clients. Three (3) of three (3) staffs interviewed stated that they are giving them more than what is necessary as they always have plenty of food for their clients. C1 reported to LPA Brown that the staffs at the facility are providing them enough food. Three (3) of three (3) staffs interviews revealed that there's no incident that happened at the facility that they did not provide food to C1 or to their clients in the quantity necessary. During the facility visit on 11/04/2024, 12/04/2024 and 12/05/2024 LPA Brown observed Staff #3's (S3) preparing and cooking food in the quantity necessary for their clients.

Based on the evidence, the allegations that facility staff did not prevent physical altercation between clients (Allegation #1) and facility staff did not provide food in the quantity necessary (Allegation #2) are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations 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: 12/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2024

LIC9099 (FAS) - (06/04)

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