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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530008
Report Date: 12/15/2022
Date Signed: 12/30/2022 11:49:47 AM

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
10/25/2022 and conducted by Evaluator Amber Coleman
COMPLAINT CONTROL NUMBER: 56-AS-20221025091344
FACILITY NAME:HOUSE OF SOLOMON RESIDENTIAL FACILITYFACILITY NUMBER:
365530008
ADMINISTRATOR:OKUNDAYE, KINGSLEYFACILITY TYPE:
735
ADDRESS:2962 NORTH RIVERSIDE AVETELEPHONE:
(609) 782-9138
CITY:RIALTOSTATE: CAZIP CODE:
92377
CAPACITY:4CENSUS: DATE:
12/15/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Kingsley Okundaye, AdministratorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
1. Lack of Supervision of Clients.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This unannounced visit by Amber Coleman, Licensing Program Analyst (LPA), is being conducted to conclude this agency’s investigation into the complaint allegations mentioned above.

During the course of the investigation, interviews were conducted with staff and witnesses; as well as a review of records.

It is alleged that the facility lacks supervision for the residents in care. Interviews with staff revealed that the facility staff consists of Kingsley Okundaye, Administrator (Admin.) and 1 other Staff Member (S1). Resident #1 (R1) was admitted to the facility on 10/18/2022. Documentation provided to the Admin. consisted of a discharge plan, medication list and emergency contact infomation. No documentation was provided to Admin regarding R1's behaviors or patterns of activity. At the time of the incident, Admin. and S1 were on duty. R1's behavior began to escalate when they ran out of cigarettes. Medication for his behaviors was provided to him with no success of changed behavior. R1 attempted to leave the facility and was followed by a staff member to give redirection back into the facility. Also, with no sucess. Evidence provided by withness, did not display the resident entering the neighboring home. Police were sent to address the matter, however a Police Report could not be obtained.

We have found the complaint allegation is unsubstantiated, although the allegation may have happened or is valid: there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of this report is being reviewed with and furnished to the facility representative.

A copy of this report was provided to Administrator Kingsley Okundaye via email.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
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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