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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320046
Report Date: 03/25/2022
Date Signed: 03/26/2022 05:03:42 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/23/2022 and conducted by Evaluator Susan Campos
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220323122257
FACILITY NAME:DROCK HOME CAREFACILITY NUMBER:
198320046
ADMINISTRATOR:ADAMSON RUKAYATFACILITY TYPE:
740
ADDRESS:1652 E CYRENE DRIVETELEPHONE:
(310) 997-8046
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY:6CENSUS: 6DATE:
03/25/2022
UNANNOUNCEDTIME BEGAN:
02:34 PM
MET WITH:Rukayat AdamsonTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
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9
Illegal eviction.
INVESTIGATION FINDINGS:
1
2
3
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5
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8
9
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13
On 3/25/2022 at 2:34pm, Licensing Program Analyst (LPA)/ Susan Campos, initiated a 10-day complaint investigation visit for the allegation listed above. LPA was allowed entry into the facility by Administrator Rukayat Adamson. LPA explained to Ms. Adamson the purpose of the visit. The investigation consisted of the following: LPA and Ms. Adamson conducted an inspection, for health and safety of the facilities’ physical plant, and food supply, LPA conducted an interview with Administrator Rukayat Adamson, and LPA was provided the following documents from Administrator Rukayat Adamson: LIC 500-Staff Roster; Client Roster; R1 Admission Agreement; and R1 Physician Report. LPA was informed by Administrator Rukayat Adamson that she did not provide R1’s POA with an eviction notice, and has not proceeded with any eviction action for R1. Per investigation, LPA will identify deficiency and citation on a Case Management LIC 809. Based on information gathered, LPA did not find sufficient evidence to support allegation " Illegal Eviction”.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated. An exit interview was conducted with Rukayat Adamson, Administrator, and a LIC 9099 hard copy was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Michael Cava
LICENSING EVALUATOR NAME: Susan Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2022
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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