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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610758
Report Date: 06/03/2026
Date Signed: 06/03/2026 01:39:57 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
05/28/2026 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20260528083448
FACILITY NAME:ALLAY GARDENS, INC.FACILITY NUMBER:
197610758
ADMINISTRATOR:ABDULLAH, MOHUMMEDFACILITY TYPE:
740
ADDRESS:7262 SUNNYSLOPE DRTELEPHONE:
(702) 612-6316
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:6CENSUS: 2DATE:
06/03/2026
UNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Mohummed AdbullahTIME COMPLETED:
01:54 PM
ALLEGATION(S):
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Staff crushed residents' medication without consent.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Evelin Rios arrived at this facility to conduct an unannounced complaint visit to investigate the above mentioned allegation. LPA was granted entry into the facility by the administrator and LPA explained the reason for the visit. An entrance interview was conducted.

The investigation consisted of the following:

From approximately 8:35 AM to 9:11 AM, LPA Rios conducted a physical plant tour of the facility to ensure the health and safety of the residents in care. During this time, LPA interviewed one (1) of two (2) residents, Residnet #2 (R2) and Residnet #1 (R1). R1 was unable to respond to interview questions due to their medical condition. No immediate health or safety concerns were observed during the tour.

(Continue to LIC9099)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026
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-20260528083448
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: ALLAY GARDENS, INC.
FACILITY NUMBER: 197610758
VISIT DATE: 06/03/2026
NARRATIVE
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From 9:12 AM to 10:00 AM, LPA interviewed the administrator and reviewed and obtained documentation, including but not limited to: residents' Physician’s Reports, Pre Admission Appraisals, Appraisal/Needs and Services Plans, R1's Centrally Stored Medication Administration Records, and R1's hospice documentation. At approximately 11:18 AM LPA Rios interviewed one (1) other staff member.

The investigation revealed the following:

Allegation: Staff crushed residents' medication without consent. Regarding the allegation, it is reported that staff crushed residents’ medications and mixed them into their food prior to serving, without the residents’ knowledge.

Interview with R2, revealed they do not receive staff assistance with medication administration. According to R2, they store and take their medication without staff assistance. LPA’s review of R2's Physician's Report dated 12/31/2025 confirms that R2 is able to manage and store their own medication and is also able to self administer their own medication. R2 confirms they have witnessed staff crush medication for R1 in the facility and place crushed medication into R1's pudding. According to R2 they have lived at this facility for about a month and this was also done at the previous facility where R1 and R2 were residing. Interview with the administrator and staff revealed they are crushing R1's medication and mixing it into soft foods. According to the administrator they are following a medication protocol continued from the previous facility and confirmed medication administration with R2's Hospice agency. The administrator also stated R2 is always told when the medication is being provided. LPA's review of R1's Physician's report dated 04/16/2026 revealed R1 is unable to administer own medication. Review of hospice documentation revealed their is physician's order in place indicating it is "ok to crush Prescription Ordered (PO) medication". Hospice documentation also noted R1 is on a puree diet.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies cited. Exit interview conducted. Copy of this report provided to the administrator.
SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2