331881266-3-12-2025-56-AS-EMAN-DFCPV8-20250402113843

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881266
Report Date: 03/12/2025
Date Signed: 03/12/2025 11:49:09 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
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/10/2025 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20250210110747

FACILITY NAME:	EMMANUEL'S GROUP HOME ARF, INC.		FACILITY NUMBER:	331881266
ADMINISTRATOR:	TAYE O DODO-WILLIAMS		FACILITY TYPE:	735
ADDRESS:	6 VILLA SCENCERO		TELEPHONE:	(818) 993-3666
CITY:	LAKE ELSINORE	STATE: CA	ZIP CODE:	92532
CAPACITY:	4	CENSUS: 2	DATE:	03/12/2025
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Licensee/Administrator Emmanuel Oyebobola		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff do not ensure medications are dispensed as prescribed.
Staff do not ensure medications are properly managed.

INVESTIGATION FINDINGS:

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On 03/12/2025 at 08:30 AM, Licensing Program Analyst (LPA) Melody Brown, visited the facility to deliver the investigative findings for the above allegations. LPA Brown identified herself and discussed the purpose of the visit with Licensee/Administrator Emmanuel Oyebobola. The investigation consisted of file review, interviews with residents and staffs as well as observation.

First allegation: Staff do not ensure medications are dispensed as prescribed. The investigation was conducted by LPA Melody Brown which consisted of observation, records review and interviews with relevant parties. The first allegation indicates that Staff do not ensure medications are dispensed as prescribed.
During the investigation, LPA Brown was not able to obtain sufficient evidence to corroborate the allegation. LPA Brown interviewed three (3) of three (3) staffs and three (3) of three (3) staffs indicated that they are all making sure that they are dispensing their clients’ medications as prescribed by their doctor. Three (3) of three (3) staffs interviewed reported ***Continuation in LIC9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

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-20250210110747

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: EMMANUEL'S GROUP HOME ARF, INC.	FACILITY NUMBER: 331881266
	VISIT DATE: 03/12/2025

NARRATIVE

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that they are using medication administration record (MAR) as their guide to ensure that they are giving their clients medications as prescribed by their physicians. LPA Brown unable to interview two (2) of two (2) clients as both clients were non-verbal. During the facility visit on 02/13/2025 and 03/12/2025, LPA Brown audited two (2) client’s medications and LPA Brown noted that staffs at the facility are dispensing their clients’ medications as prescribed by their physician as LPA Brown did not observe any issue.

Second allegation: Staff do not ensure medications are properly managed. The investigation was conducted by LPA Melody Brown which consisted of file review, observation, and interviews with relevant parties. During the investigation, LPA Brown was not able to obtain sufficient evidence to support that Staff do not ensure medications are properly managed. Interviews with three (3) of three (3) staffs indicated that they are all ensuring that they are properly managing their clients’ medications. Three (3) of three (3) staffs interviewed stated that they are utilizing Centrally Stored Medication and Destruction Record (LIC622) to ensure that they are properly managing their clients’ medications. LPA Brown unable to interview two (2) of two (2) clients as both clients were non-verbal. During the facility visit on 02/13/2025 and 03/12/2025, LPA Brown noted that the facility maintains Centrally Stored Medication and Destruction Record (LIC622) for their two (2) clients.

Therefore, based on the evidence obtained during LPA Brown's investigation, there is insufficient evidence to prove that Staff do not ensure medications are dispensed as prescribed (Allegation #1), Staff do not ensure medications are properly managed (Allegation #2) are UNSUBSTANTIATED at this time. Although the allegation of Staff do not ensure medications are dispensed as prescribed (Allegation #1), Staff do not ensure medications are properly managed(Allegation #2) 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 (LIC9099), was discussed and provided to Licensee/Administrator Emmanuel Oyebobola.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

LIC9099 (FAS) - (06/04)

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