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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197606938
Report Date: 11/20/2025
Date Signed: 11/20/2025 12:51:03 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/18/2025 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20251118152752
FACILITY NAME:AUTUMN HILLS RESIDENTIAL HOME, INC.FACILITY NUMBER:
197606938
ADMINISTRATOR:AUGUSTINE KEHINDEFACILITY TYPE:
740
ADDRESS:43129 LEMONWOOD DRIVETELEPHONE:
(661) 943-8194
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:6CENSUS: 4DATE:
11/20/2025
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Adebisi Ogunsaju - Administrator DesigneeTIME COMPLETED:
01:05 PM
ALLEGATION(S):
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Staff does not provide resident with assistance.
Staff do not treat resident(s) with dignity and respect.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced complaint visit at this facility for the above allegations. LPA was greeted and granted access by Staff#1 (S1). The administrator, Augustine Kehinde could not meet LPA. LPA met with the administrator designee, Adebisi Ogunsaju shortly after. LPA explained the reason for the visit.

To investigate the allegations LPA initiated a physical plant tour of the facility to ensure the health and safety of residents in care. LPA did not observe any health or safety concerns. While conducting the tour, from 9:33 a.m., to 10:30 a.m., LPA interviewed four (4) out of four (4) residents and two (2) staff. At approximately 10:30 a.m., LPA obtained and reviewed copies of the facility's roster, personnel report (LIC500), resdients' admission agreements, resdients' physician's reports, and residents' appraisals.

(Continue to LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
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 31-AS-20251118152752
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: AUTUMN HILLS RESIDENTIAL HOME, INC.
FACILITY NUMBER: 197606938
VISIT DATE: 11/20/2025
NARRATIVE
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(Continued from LIC9099)
Allegation: Staff does not provide resident with assistance. In regards to the allegation, it was reported that staff are not assisting Resident #1 (R1) with Activities of Daily Living (ADLs) such as bathing, cleaning or ambulating. LPA's interview with one (1) out of the four (4) residents stated that staff initially helped them with bathing and transferring out of bed. However, the resident later refused further assistance due to Staff #1’s (S1) rude behavior and lack of effort. The resident reported that S1 made dismissive remarks, such as stating they "don’t have time to assist". Interview with three (3) out of four (4) residents reported they receive varying degrees of assistance with ADLs from staff based on their own ability and denied having issues receiving such assistance when they need it or ask for it. Although one (1) of these residents denied the allegation they stated S1 had been rude when they had asked for an item. Four (4) out of four (4) residents deny witnessing staff refuse to provide assistance to other residents. LPA's interview with staff denied the allegation, reporting that assistance is offered regularly, but some residents decline help, telling staff, they are capable of doing things independently. LPA's review of R1's physician's report revealed R1's physician checked that R1 has the capacity for self-care.

Although the allegation may have happened or is valid, there is not enough evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time

Allegation: Staff do not treat resident(s) with dignity and respect. In regards to the allegation it was reported, that Resident #1 (R1) was told to go back to their room because they were being too noisy. During interviews with staff, staff denied the allegation. According to Staff #1 (S1), they have a routine cleaning schedule and had asked R1 to return to their room only until they had finished cleaning. Interview with staff deny telling any resident they are being too noisy. LPA's interview with two (02) out of four (04) residents reported they feel staff do not treat them with dignity and respect. All other residents stated they feel staff treat them with respect and dignity. LPAs interview with four (4) out of four (4) residents deny witnessing staff being disrespectful to other residents.

Based on interviews, and conflicting information there is not enough evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED at this time.

Exit interview was conducted and a copy of the report was provided.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2