331881158-5-1-2026-18-AS-CTUA-DUB6V2-20260521210757

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881158
Report Date: 05/01/2026
Date Signed: 05/01/2026 11:27:39 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
03/23/2026 and conducted by Evaluator Janira Arreola

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20260323165811

FACILITY NAME:	OLIVER ADULT RESIDENTIAL FACILITY		FACILITY NUMBER:	331881158
ADMINISTRATOR:	OGONNA ONYEMATA		FACILITY TYPE:	735
ADDRESS:	13675 OLIVER STREET		TELEPHONE:	(951) 289-2731
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92555
CAPACITY:	6	CENSUS: 2	DATE:	05/01/2026
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Staff, Dion Mcleod		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff do not adequately supervise resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Janira Arreola and Venus Mixson conducted an unannounced visit in order to deliver findings to the facility. LPAs identified themselves and informed on the purpose of the visit. LPAs met with Staff, Dion Mcleod.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2026

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 4

Control Number 18-AS-20260323165811

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: OLIVER ADULT RESIDENTIAL FACILITY	FACILITY NUMBER: 331881158
	VISIT DATE: 05/01/2026

NARRATIVE

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"Staff do not adequately supervise resident in care."

It was alleged that staff were not supervising Client #1 (C1) during an outing in the community where a member of the community was injured by C1.

LPA attempted to conduct an interview with C1, however C1 was unable to communicate and answer interview questions. LPA conducted (2) staff interviews which revealed that Staff #1 (S1) is a one to one staff for C1. Staff revealed that C1 requires a one to one staff in order to keep C1 safe. Staff including S1 revealed on 03/16/2026, S1 was with C1 at the park. S1 revealed they were standing next to C1 when they ran away and S1 followed C1. S1 revealed that C1 hit a community member and called a second staff to meet them to assist in calming C1 down from the incident. Interviews with staff revealed that they had asked the Regional Center for C1 to have a (2) to (1) assistance for C1 prior to the 03/16/2026 incident.

LPA reviewed C1's Activity Schedule/ Behavior Escalation Guidelines which revealed a behaviorist plan for C1's behavior Crisis Prevention Strategies. On Page 3, Item 5, it states CPI Interim Control Position Two Man Control Position to be used if C1 present a threat to themselves or others.

Based on LPA’s interviews conducted and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is substantiated. California Code of Regulations is being cited on the attached LIC 9099 D. An exit interview was conducted, and a copy of this report was provided.

SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
03/23/2026 and conducted by Evaluator Janira Arreola

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20260323165811

FACILITY NAME:	OLIVER ADULT RESIDENTIAL FACILITY		FACILITY NUMBER:	331881158
ADMINISTRATOR:	OGONNA ONYEMATA		FACILITY TYPE:	735
ADDRESS:	13675 OLIVER STREET		TELEPHONE:	(951) 289-2731
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92555
CAPACITY:	6	CENSUS: 2	DATE:	05/01/2026
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Staff, Dion Mcleod		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Licensee does not ensure that staff are adequately trained.

INVESTIGATION FINDINGS:

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"Licensee does not ensure that staff are adequately trained."

It was alleged that staff present with C1 at an outing and was not properly trained to address C1's behaviors. LPA attempted to conduct an interview with C1, however C1 was unable to communicate and answer interview questions. LPA conducted (2) staff interviews which revealed an incident where S1 was with C1 on an outing when they had a behavior. (2) staff including S1 revealed that they have been trained by a behaviorist and have received Crisis Prevention Intervention (CPI) training. S1 revealed they monitor C1's behavior and adjust their approach based on C1's needs.

LPA conducted a records review for S1 which revealed Direct Support Professional (DSP) training for Year One for 35 hours completed, and DSP training for Year Two for another 35 hours completed. S1 has been trained on behavioral intervention techniques on 02/15/2025, and CPI training conducted on 07/07/2025. Therefore, the allegation was found to be unsubstantiated.

Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was provided.

An exit interview was conducted where this report was reviewed and provided to staff.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Citations on this Visit Report are Under Appeal!

Control Number 18-AS-20260323165811

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: OLIVER ADULT RESIDENTIAL FACILITY	FACILITY NUMBER: 331881158
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/01/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Under Appeal Type B 05/08/2026 Section Cited CCR 80065(a)	1 2 3 4 5 6 7	80065 Personnel Requirements (a) Facility personnel shall...at all times, be employed in numbers necessary to meet such needs. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The licensee agreed to submit a documented plan for ensuring C1's behavioral plan and crisis prevention techniques can be employed by sufficient fingerprint cleared...
	8 9 10 11 12 13 14	Based on interviews and records review, staff were not in sufficient numbers to assist C1 during an outing and poses a potential health safety or personal rights risk to clients in care.	8 9 10 11 12 13 14	....and trained staff in order to meet C1's needs. This is due by the POC due date.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2026

LIC9099 (FAS) - (06/04)

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