Complaint Investigation Report

On 09/10/2025 an initial visit was conducted by LPA Casillas and North Los Angeles Regional Center (NLARC) Community Services Specialist (CSS) Rachel Cooper. On that day LPA conducted a tour of the facility, interviewed facility staff, interviewed Licensee, interviewed clients and obtained copies of pertinent information related to the investigation. At the time of the visit an interview was conducted with then Administrator Vashan Bobney.

Allegation #1: Staff chemically restrained residents in care.

This allegation investigation was conducted by Jose Santana, Investigator from Community Care Licensing Division of Investigations Branch (IB). The investigation consisted of interviews by IB with three (3) witnesses, eight (8) facility staff to include one on one staff (1:1) as some staff work both as DSP and 1:1, facility Administrator Bobney, three (3) out of four (4) facility clients, eight (8) hospital staff/specialists, reviews of Client #1 (C1)’s medical records, police records, and facility program plan.

It was alleged that around June and July 2025 facility staff were chemically restraining C1 with medication that was not prescribed to C1. During the investigation C1 denied being given medication that matched the medication in question’s appearance. IB determined through extensive medical record reviews and interviews that this investigation did not find sufficient evidence to prove C1 was given unprescribed medication. It was also stated by C1’s psychiatrist that the medication in question could not act as a chemical restraint because it only has mild melatonin-like effects. The medication in question additionally would not have had any drug interaction with C1’s prescribed medications. Medical records revealed that during the period in question, June-July 2025, C1 did not present with injury when examined at the hospital, with the exception of preexisting conditions. Therefore, based on interviews, record reviews, and observations the allegation is deemed unsubstantiated.