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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881302
Report Date: 10/09/2025
Date Signed: 10/09/2025 02:05:35 PM

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
10/04/2025 and conducted by Evaluator Hannah Rodgers
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20251004203516
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:
10/09/2025
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:House Manager Innocent OkwudifeleTIME COMPLETED:
02:10 PM
ALLEGATION(S):
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Staff did not provide transportation to clients.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced visit to initiate and deliver findings regarding the above complaint allegation. LPA introduced herself and disclosed the purpose of the visit to House Manager Innocent Okwudifele.

On October 4, 2025, it was alleged that staff did not provide transportation to clients. It was alleged that Client #1 (C1) required transportation from their day program back to the facility due to C1 having stomach pain, to which the facility did not provide. The Department’s investigation consisted of an unannounced facility visit, records review, and staff, client, and outside source interviews.

(CONTINUED ON LIC9099-C)

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Hannah Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
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 2
Control Number 56-AS-20251004203516
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: 10/09/2025
NARRATIVE
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Per record review and staff interviews, on October 1, 2025, C1 arrived at their day program complaining of stomach pain. The staff at the day program reached out to the facility staff asking for C1 to be picked up. Facility staff were unable to pick up C1 at the time and asked the day program staff to transport C1 to the hospital via emergency services, to which day program staff did later that afternoon. Internal interviews revealed that there were three (3) staff members at the facility at the time C1 was asked to be picked up. Two (2) of the three (3) staff members were on site at the facility with Client #2 (C2). Per interviews, C2 had a Regional Center specified staff-client ratio of two (2) staff members to one (1) client. The third staff member was at an appointment with Client #3 (C3).

Review of C1’s physician’s report dated June 11, 2025, revealed that C1 had the capacity for self-care and could leave the facility unassisted. Interviews corroborated C1’s capacity for self-care thus explained the reasoning as to the facility staff requesting day program staff to transport C1 via emergency services if C1 was having a medical emergency.

Based on interviews and records review, the investigation did not yield a preponderance of evidence to conclude that staff did not provide transportation to clients. Based on the foregoing, the allegation is unsubstantiated. This finding means that although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with House Manager Innocent Okwudifele, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Hannah Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2