331881149-9-8-2021-18-AS-EMAN-C9VPHD-20211220101942

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881149
Report Date: 09/08/2021
Date Signed: 09/08/2021 11:33:24 AM

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
08/31/2021 and conducted by Evaluator Jennifer Semin

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210831091936

FACILITY NAME:	DIVINE RESIDENTIAL HOME		FACILITY NUMBER:	331881149
ADMINISTRATOR:	OLOSO, IFEOLUWA VICTORIA		FACILITY TYPE:	735
ADDRESS:	18900 STONEWOOD WAY		TELEPHONE:	(951) 579-1470
CITY:	LAKE ELSINORE	STATE: CA	ZIP CODE:	92530
CAPACITY:	4	CENSUS: 4	DATE:	09/08/2021
		UNANNOUNCED	TIME BEGAN:	09:47 AM
MET WITH:	Bolagi Akimeulero		TIME COMPLETED:	11:48 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff pushed client.
Staff teased client about their disability.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Jennifer Semin conducted an unannounced visit to investigate and deliver the findings for the above complaint allegations. LPA met with Esther Akanji. Licensee Bolagi Akimeulero arrived during the visit. The investigation consisted of interviews with staff, clients and relevant parties. The first allegation, staff pushed client, interviews with clients revealed that Client 1 (C1) stated they were pushed by staff but there were no witnesses to corroborate the allegation. Other clients interviewed stated they have never been pushed or physically abused by any staff nor witnessed any staff physically abusing any client. Staff 1-3 deny physically abusing any client nor have they witnessed any staff physically abusing any client. Investigation did not reveal further information to either refute or corroborate the allegation. The second allegation that staff teased client abouit their disability, interviews revealed that all Clients and all staff denied that staff have ever teased any client in care. Investigation did not reveal further information to either refute or corroborate the allegation. Based upon interviews and information gathered, and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED at this time.
An exit interview was conducted where this report was discussed and provided to Ms. Akimeulero.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Jennifer Semin
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

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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