<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191201925
Report Date: 10/17/2023
Date Signed: 10/17/2023 05:26:37 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, 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
08/04/2023 and conducted by Evaluator Abeye Duguma
COMPLAINT CONTROL NUMBER: 31-AS-20230804113113
FACILITY NAME:LARC ADULT HOME IFACILITY NUMBER:
191201925
ADMINISTRATOR:STURKEY, KATHYFACILITY TYPE:
735
ADDRESS:29898 N BOUQUET CANYON RDTELEPHONE:
(661) 296-8636
CITY:SAUGUSSTATE: CAZIP CODE:
91350
CAPACITY:72CENSUS: 64DATE:
10/17/2023
UNANNOUNCEDTIME BEGAN:
10:03 AM
MET WITH:Chris BratzelTIME COMPLETED:
05:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not appropriately supervise residents, resulting in a resident being inappropriately touched by another resident.
Staff did not adequately supervise residents, resulting in a resident stealing from another resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to this facility to investigate the above allegations. LPA met with Chris Bratzel and explained the reason for the visit.

--- Staff did not appropriately supervise residents, resulting in a resident being inappropriately touched by another resident.

It was alleged that Resident #1 (R1) was inappropriately touched by Resident #2 (R2). To investigate the allegation, on 08/08/2023 LPA interviewed staff between 12:30 PM to 02:00 PM. On 10/17/2023, LPA interviewed six (06) residents and other parties from 2:30 PM to 4:30 PM.

(CONT. on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
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-20230804113113
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LARC ADULT HOME I
FACILITY NUMBER: 191201925
VISIT DATE: 10/17/2023
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
During interviews with staff and other parties, they all stated the incident did not take place and could not have taken place because R2 has 24-hour supervision and, at the request of R2’s responsible party, is never allowed to be around or in the same area as R1. Staff also added that a police report was filed, but that all allegations were unfounded. During interviews with residents, R1 stated they never had a relationship with R2, that R2 touched them inappropriately, but that there were no witnesses at the time of the incident. R2 stated they do not communicate with R1, has never been a relationship with R1 and never touched R1 inappropriately. All other residents stated they have never seen R2 touch R1 inappropriately.

Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

--- Staff did not adequately supervise residents, resulting in a resident stealing from another resident.

It was alleged that R1’s roommate steals from them. To investigate the allegation, on 08/08/2023 LPA interviewed staff between 12:30 PM to 02:00 PM. On 10/17/2023, LPA interviewed (six) residents and other parties from 2:30 PM to 4:30 PM. During interviews with staff, they all stated R1’s story and the items missing changed every time R1 was questioned. Staff added that a police report was filed, but the allegations were all unfounded. During interviews with residents, R1 stated they believe that their roommate stole their pencil. All other residents, including the roommate, stated they have never stolen anything from any of the residents.

Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards were noted during the visit.

Exit interview conducted and a copy of the report was issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2