331881143-12-27-2024-56-AS-EMAN-DDAKVR-20250126071445

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881143
Report Date: 12/27/2024
Date Signed: 12/27/2024 02:18:25 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
12/04/2024 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20241204095349

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 seek medical attention for resident.
Facility staff hit resident in the face.
Facility staff stole money from resident.

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 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 first allegation indicates facility staff did not seek medical attention for resident. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with three (3) of four (4) clients interviewed indicated that staffs at the facility are seeking medical attention for them if needed. Also, three (3) of four (4) clients stated that they don't remember an incident that staffs at the facility did not seek medical attention for Client #1 (C1). Three (3) of four (4) clients interviewed reported that they don't know of an incident that happened ***Continuation in 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-20241204095349

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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in 06/2024 that C1 had a stroke and that staffs at the facility did not seek medical attention for C1.
Interviews with three (3) of three (3) staffs indicated that they always seek medical attention for a client if needed. Three (3) of three (3) staffs interviewed stated that there's no incident in 06/2024 that C1 had a stroke and that they did not seek medical attention for C1. Three (3) of three (3) staffs interviewed revealed that they always seek medical attention for all their clients if needed. LPA Brown cross reference the San Bernardino Unusual Incident/Injury Reports received and there's no incident reported that C1 had an incident or C1 had a stroke in 06/2024.

The second allegation indicates facility staff hit resident in the face. Interviews with three (3) of four (4) clients indicated that they were not aware of an incident at the facility that a staff hit a client in the face. Three (3) of four (4) clients interviewed reported that they did not witness or hear any incident that a staff hit C1 in the face. Interviews with three (3) of three (3) staffs indicated that there's no incident that happened at the facility that a staff hit their clients in the face. Three (3) of three (3) staffs interviewed stated that no staff at the facility hit C1 in the face. Three (3) of three (3) staffs interviewed revealed that in 11/15/2024, it was C1 who pulled Staff #3's (S3) hair, chased S3 and punched Staff #2 (S2) in the face. Three (3) of three (3) staffs interviewed added that due to C1 chasing S3, the front door of the facility was broken off and S3 called local law enforcement for assistance as they cannot control C1's aggressive behavior. Three (3) of three (3) staffs interviewed reported that in 11/15/2024, the local law enforcement asked S2 if S2 wants to press charges and S2 declined, and the local law enforcement transported C1 to the nearest Emergency Treatment Services (ETS).

The third allegation indicates facility staff stole money from resident. 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 hear or witness an incident that a staff at the facility stole money from a client. Three (3) of four (4) staffs interviewed stated that there's no incident that happened at the facility that they witnessed or heard happened that a staff stole money from C1. Interview with C1 revealed that it was Client #2 (C2) who took C1's phone and purchased items from stores and transferred money from C1's account to C2 and C1's girlfriend as evidenced of the purchased and money transfer alerts that C1 received and showed to LPA Brown during the facility visit on 12/04/2024. Interviews with three (3) of three staffs indicated that there's no staff at the facility that stole money from a client. Three (3) of three (3) staffs stated that there's no staff at the facility that stole money from C1. ***Continuation in LIC9099C***

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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Control Number 56-AS-20241204095349

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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Three (3) of three (3) staffs interviewed reported that when the local police arrived at the facility in 12/04/2024, they were informed that it was C2 who made the multiple online purchased and money transfers from C1's account using C1's phone and C2 must pay it back to C1. Furthermore, C1 Inland Regional Center (IRC) Consumer Services Coordinator (CSC) informed LPA Brown that C1 has a history of violent, and manipulation behavior.

Based on the evidence, the allegations that facility staff did not seek medical attention for resident (Allegation #1), facility staff hit resident in the face (Allegation #2), facility staff stole money from resident (Allegation #3) are 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: 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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