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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881302
Report Date: 09/11/2025
Date Signed: 09/11/2025 10:17:45 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
05/28/2025 and conducted by Evaluator Beena Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250528095624
FACILITY NAME:PASSIONATE HOME 1FACILITY NUMBER:
331881302
ADMINISTRATOR:OLAJUMOKE IJABADENUYIFACILITY TYPE:
735
ADDRESS:29340 GRAND SLAMTELEPHONE:
(323) 671-6789
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92530
CAPACITY:4CENSUS: 4DATE:
09/11/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Facility House manager-Innocent Okwudifele TIME COMPLETED:
10:40 AM
ALLEGATION(S):
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9
Staff are not properly supervising client resulting in elopements.
Staff are not providing clients with reasonable level of privacy in their bedrooms.
Staff are not providing clients with access to the home.
Staff are not dispensing medication as prescribed.
INVESTIGATION FINDINGS:
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On 09/11/2025, Licensing Program Analyst (LPA) Beena Singh visited the facility to deliver the investigative findings for the above allegation. LPA Singh identified herself and discussed the purpose of the visit with Facility House Manager Innocent Okwudifele.

The investigation was conducted by LPA Beena Singh. The investigation consisted of file review, observation and interviews with relevant parties.

First Allegation: Staff are not properly supervising clients resulting in elopements, Evidence shows that staff at the facility are properly supervising clients and C#1 was allowed to leave the facility unassisted without supervision. Interviews with three (3) Staff out of three (3) staff indicated that Client#1 can go out without supervision. One (1) client out of three (3) clients stated only client#1 was allowed to go out of the facility without supervision and other three clients’ needs supervision. Also, according to Inland Regional Center (IRC) Individual Program Plan (IPP) records review Client#1 does not needs constant medical supervision. Facility staff provides transportation to and from medical appointments and assist C#1 when he needs assistance with transportation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
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 3
Control Number 56-AS-20250528095624
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: PASSIONATE HOME 1
FACILITY NUMBER: 331881302
VISIT DATE: 09/11/2025
NARRATIVE
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Second Allegation: Staff are not providing clients with a reasonable level of privacy in their bedrooms.

During the investigation, LPA Singh could not find enough evidence to support the allegation. LPA Singh interviewed three (3) out of three (3) staff and One (1) out of three (3) clients (Client#2 is non-verbal and client#1 is not available for the interview), denied the allegation Staff are not providing clients with a reasonable level of privacy in their bedrooms. as staff stated client#1 is independent and does not need staff assistance, two other clients’ needs supervision, Staff are always ready to assist if C#1 ask or needed assistance and staff stated they always provide clients reasonable level of privacy in their bedrooms. C#3 stated staff always provides the clients privacy in their bedrooms and C#3 has no issues.

Third Allegation: Staff are not providing clients with access to the home.

During the investigation, LPA Singh could not find enough evidence to support the allegation. LPA Singh interviewed three (3) out of three (3) staff and One (1) out of three (3) clients (Client#2 is non-verbal and client#1 is not available for the interview), three (3) out of three (3)staff and one(1) out of three (3)clients denied the allegation that staff are not providing clients with access to the home.

Fourth Allegation: Staff are not dispensing medication as prescribed.

During the investigation, LPA Singh could not find enough evidence to support the allegation. LPA Singh interviewed three (3) out of three (3) staff, who stated they are dispensing client medications as prescribed by physician, using the medication administration record (MAR) as their guide. LPA Singh was unable to interview two of the three clients. Client#2 is non-verbal, and staff reported that client#1 has left the facility. Client#3 stated staff always gives medication on time and never had any issues. On two separate visits (05/29/2025 and 09/11/2025), LPA Singh audited the medications of three clients and found no issues. The staff appeared to be dispensing medications correctly, as prescribed by physicians. Also, according to Inland Regional Center (IRC) Individual Program Plan (IPP) Client#1 can administer and store own medications. In conclusion, LPA Singh did not found any issues with medication dispensing at the facility.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20250528095624
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: PASSIONATE HOME 1
FACILITY NUMBER: 331881302
VISIT DATE: 09/11/2025
NARRATIVE
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Therefore, based on the evidence obtained during the Department's investigation, the allegations that Staff are not properly supervising clients resulting in elopements, Staff are not providing clients with a reasonable level of privacy in their bedrooms, Staff are not providing clients with access to the home and Staff are not dispensing medication as prescribed are Unsubstantiated at this time.

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 (LIC9099) was discussed and provided to House Manager Innocent Okwudifele.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3