195850303-4-10-2025-29-AS-KLOZ-DG86B7-20250429203927

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850303
Report Date: 04/10/2025
Date Signed: 04/10/2025 04:03:52 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/22/2024 and conducted by Evaluator Erica Mosley

COMPLAINT CONTROL NUMBER: 29-AS-20240722215837

FACILITY NAME:	COMFORT PLACE LTD, THE		FACILITY NUMBER:	195850303
ADMINISTRATOR:	OLUWOLE, KEMI		FACILITY TYPE:	740
ADDRESS:	11905 RIVERSIDE DRIVE		TELEPHONE:	(213) 570-2025
CITY:	VALLEY VILLAGE	STATE: CA	ZIP CODE:	91607
CAPACITY:	6	CENSUS: 6	DATE:	04/10/2025
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Omowunmi Balogun - Administrator		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are stealing a resident's personal documents
Staff are financially abusing a resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced subsequent complaint visit to investigate the above allegations. The purpose of this visit is to deliver findings for the above allegations. Upon arrival at 9:45 a.m., LPA Mosley was greeted by Staff and Administrator / (Licensee representative). The LPA met with Administrator, Omowunmi Balogun and explained the reason for the visit.

On 07/22/2024 the Department received a complaint regarding the following allegations, Staff are stealing a resident's personal documents, and Staff are financially abusing a resident. On 07/31/2024 LPA, Esther Cortez conducted an unannounced initial 10-day complaint visit. Between 01:15 p.m. and 2:30 p.m. LPA toured the facility with the administrator, interviewed the Administrator, conducted a file review, and obtained copies of resident records and other pertinent documents relevant to the investigation.

Report continued on LIC 9099-C PAGE 2...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025

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 4

Control Number 29-AS-20240722215837

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: COMFORT PLACE LTD, THE	FACILITY NUMBER: 195850303
	VISIT DATE: 04/10/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(PAGE 2) REPORT CONTINUED FROM LIC 9099...
On 04/09/2025 LPA, Mosley conducted an unannounced subsequent complaint visit. From 12:46p.m.- 2:20p.m. LPA conducted a brief physical plant tour, conducted in person interviews with the Administrator, two (2) staff, two (2) residents, a file review and obtained copies of pertinent documents relevant to the investigation.

During today’s visit, at 9:48 a.m. LPA conducted the entrance interview and a brief physical plant tour to ensure there are no immediate health and safety concerns and facility is in compliance with Title 22 Regulations. From 9:02 a.m.- 1:15p.m LPA conducted three (3) telephonic interviews with Resident # 1(R1) emergency contact (E.C) #1, R1’s E.C #2, R1’s California Department of Health Care Services (DHCS) Case worker (CW), an in-person interview with the Administrator, brief file review, and obtained copies of pertinent documents relevant to the investigation.

On the allegation Staff are stealing a resident's personal documents it is the concern of the reporting party (RP) that the facility Licensee representative is stealing R1’s personal documents including ID card. To investigate this complaint, LPA conducted in person interviews with two (2) staff members, Administrator / Licensee representative, two (2) residents including R1, telephonic interviews with R1’s E.C #1, R1 E.C #2, R1 DHCS case worker, and a file review. Interviews with the staff revealed that they do not enter R1’s room without permission and without R1 being present. Interviews revealed R1 has a tendency to misplace things and blame the staff for things going missing. Later R1 will apologize to the staff and state that the items were found. Since misplacing things is a reoccurring thing for R1 the staff and R1 had made a written and verbal agreement in March 2024 that staff will only enter R1’s room when R1 is present. Staff state that they have not taken or stolen any personal documents including R1’s ID card. Interview with the Administrator / Licensee representative revealed that R1 has made allegations in the past that personal belongings have gone missing, and that staff are stealing personal belongings. Administrator / Licensee representative stated that R1 will later apologize to the staff and state that the items were found. Since misplacing things is a reoccurring thing for R1 In March 2024 that Administrator / Licensee representative made a written and verbal agreement with R1 that staff will only enter R1’s room when R1 is present to try and give R1 more confidence in the staff.

Report continued on LIC 9099-C PAGE 3...

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 29-AS-20240722215837

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: COMFORT PLACE LTD, THE	FACILITY NUMBER: 195850303
	VISIT DATE: 04/10/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(PAGE 3) REPORT CONTINUED FROM LIC 9099-C PAGE 2...

Administrator / Licensee representative stated that she has not taken or stolen any personal documents including R1’s ID card. Interviews with R1’s E.C #1 revealed that R1 was willingly placed at the facility with assistance from E.C #2. E.C #1 stated that R1 did not have any possession of any personal documents including ID card as E.C #2 has possession of all legal documentation for safeguarding. R1 has a copy of the ID card. Interview with CDHS CW revealed that R1 has reoccurring behaviors that include confrontation with staff and making accusations about the staff. CDHS CW states that the facility staff did not take her personal documents including ID card. File review revealed that on R1’s LIC 621 Residents personal property and valuables record sheet, ID card was not listed. Interview with R1 revealed that they have a copy of their ID but have had difficulty obtaining a physical copy. R1 stated that they are unsure what happened to their ID card. LPA educated R1 on the procedures and resources on how to obtain a physical ID card. R1 stated that at times they misplace things, but the items are typically found at a later time. Based on information obtained, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of Staff are stealing a resident's personal documents is deemed unsubstantiated at this time.

On the allegation Staff are financially abusing a resident it is the concern of the reporting party (RP) that the facility Licensee representative is stealing R1’s personal assets, including assets in another state and R1’s identity. To investigate this complaint, LPA conducted an in person interviews the Administrator / Licensee representative, R1, telephonic interviews with R1’s E.C #1, R1 E.C #2, R1 DHCS case worker, and a file review. Interviews with the Administrator / Licensee representative revealed that R1 was willing admitted to the facility with R1’s E.C #2. All R1’s family is involved and cooperative with the facility and R1’s wellbeing. Administrator / Licensee representative states that they are unaware of any of R1’s assets or finances as they do not handle or store any of R1’s finances or personal belongings. All the residents at the facility handle their own finances as the facility does not safeguard money for the residents. Administrator / Licensee representative stated they have not and do not plan to steal R1’ s personal assets or identity.

Report continued on LIC 9099-C PAGE 4...

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20240722215837

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: COMFORT PLACE LTD, THE	FACILITY NUMBER: 195850303
	VISIT DATE: 04/10/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(PAGE 4) REPORT CONTINUED FROM LIC 9099-C PAGE 3...

Interview with R1’s E.C #1 revealed that R1 does not have any personal assets, and nothing has been stolen. Interview with CDHS CW revealed that R1 does not have any personal assets. R1 struggles with their mental health. R1 has reoccurring behaviors that include confrontation with staff and making accusations about the staff. CDHS CW was not aware of the facility stealing any assets or R1’s identity. Interviews with R1 revealed that they handle all of their own finances and have no issues or concerns with their personal finances. R1 stated they have no problem with the facility staff and the staff do not handle any of their personal finances or personal belongings. Based on information obtained, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of Staff are financially abusing a resident is deemed unsubstantiated at this time.

No deficiencies were observed during today’s inspection. Exit interview conducted. Report was reviewed and a copy was provided. A copy and appeal rights were issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 4