331881302-8-22-2025-56-AS-EMAN-DLYPR8-20250929113218

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881302
Report Date: 08/22/2025
Date Signed: 08/22/2025 01:25:59 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
04/11/2025 and conducted by Evaluator Paola Guerrero

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20250411144950

FACILITY NAME:	PASSIONATE HOME 1		FACILITY NUMBER:	331881302
ADMINISTRATOR:	OLAJUMOKE IJABADENUYI		FACILITY TYPE:	735
ADDRESS:	29340 GRAND SLAM		TELEPHONE:	(323) 671-6789
CITY:	LAKE ELSINORE	STATE: CA	ZIP CODE:	92530
CAPACITY:	4	CENSUS: 4	DATE:	08/22/2025
		UNANNOUNCED	TIME BEGAN:	09:38 AM
MET WITH:	Innocent Okwudifele- House Manager		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff did not report a client outing to client's authorized representative.
Staff did not provide client medication as prescribed.
Staff failed to accompany client to an appointment.
Staff spoke inappropriately in the presence of a client in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Manager Innocent Okwudifele and explained the purpose of the visit. The investigation consisted of interviews, observations, and review of records.

First allegation: Staff did not report a client outing to client's authorized representative. Regarding the first allegation LPA conducted interviews with S#1, S#2, and S#3, who informed LPA that C#1 was able to leave the facility unsupervised. S#1-3, informed LPA that C#1 needs to inform the facility upon every outing by signing the facility sign in/and out log. LPA conducted a record review pertaining to C#1, and LPA discovered that based on C#1 Individual Program Plan (IPP), Client #1 was able to leave the facility and go out into the community unsupervised. In addition, based on IPP client, was to return to the facility at a reasonable time. Furthermore, records did not indicate that C#1 was to report outings to clients authorized representative. During review of records LPA observed C#1 physician’s report listed that C#1 was able to leave facility unsupervised. In addition, during record review LPA observed that on several occasions Passionate Home 1 made reports in reference to C#1 not returning to the facility until the next day and as a result C#1 would not take the medication as indicated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025

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-20250411144950

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: PASSIONATE HOME 1	FACILITY NUMBER: 331881302
	VISIT DATE: 08/22/2025

NARRATIVE

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Second allegation: Staff did not provide client medication as prescribed. Regarding the allegation stated above LPA conducted interviews with Staff #1, Staff #2, and Staff #3, who informed LPA that facility is not authorized to make medication orders for C#1. S#1-3 further informed LPA that C#1, and client’s mother are the only individuals that can make or authorize any order pertaining to client #1. During review of records LPA observed that Passionate Home 1 had reported that on 2/3/2025 and 2/4/2025, facility attempted to refill C#1 medication however, pharmacy informed facility that they are not authorized to make any orders for C#1. Pharmacy informed facility that C#1 and clients authorized representative can only authorize orders pertaining to C#1. Facility reported that C#1 was not able to receive medication on the dates listed because facility was not authorized. During review of Client #1 records LPA observed that C#1 mother was clients otherized representative and payee.

Third allegation: Staff failed to accompany client to an appointment. Regarding the allegation LPA conducted interviews with Staff #1, Staff #2, and Staff #3, who informed LPA that on 4/10/2025 Client #1 had court and staff had requested an UBER Staff#1 informed LPA that when C#1 was picked up by UBER that Staff #1 later received notification that the UBER trip was halted halfway and C#1 did not proceed to be transported to clients court appointment. Staff #1 informed LPA that C#1 was later with parent and facility was informed that C#1 did not attend court. LPA conducted interviews with Client #4 and Client #5 regarding the allegation stated above and both C#4 and C#5 informed LPA that staff has not denied or failed to transport clients to their appointments.

Fourth allegation: Staff spoke inappropriately in the presence of a client in care. Regarding the allegation LPA conducted interviews with Staff #1, Staff #2, and Staff #3 LPA went over the allegation with staff and all staff denied the allegation of “speaking inappropriately in the presence of clients”. LPA conducted interviews with Client #4 and Client #5 LPA went over the allegations with both clients who informed LPA that they have not witnessed staff speak inappropriately in the presence of clients. Client #4 and Client #5, informed LPA that all staff are respectful and kind. Based on corroborating evidence obtained during the course of the investigation, LPA has determined that the above allegation is Unsubstantiated.

Unsubstantiated: meaning that 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.

An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility House Manager Innocent Okwudifele at the end of the visit.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025

LIC9099 (FAS) - (06/04)

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