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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191221435
Report Date: 03/12/2025
Date Signed: 03/12/2025 03:28:05 PM

Substantiated


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
03/12/2024 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20240312124123
FACILITY NAME:BROOKDALE CHATSWORTHFACILITY NUMBER:
191221435
ADMINISTRATOR:HELEN LEEFACILITY TYPE:
740
ADDRESS:20801 DEVONSHIRE BLVDTELEPHONE:
(818) 341-2552
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY:268CENSUS: 111DATE:
03/12/2025
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Amanda Monroy, AdministratorTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Resident was sexually abused by another resident in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced subsequent visit to this facility to deliver the final report. LPA met with Executive Director and explained the reason for the visit.

On 03/12/2024, the Woodland Hills South Adult and Senior Care Regional Office received a complaint regarding the allegation, “Resident was sexually abused by another resident in care." The complaint was referred to Community Care Licensing Division’s Investigations Branch. The complaint was assigned to investigator Jose Santana.

On 03/14/24 LPAs Panushkina, Ngo-Castaneda, and Khurshudyan initiated the complaint. LPAs conducted tour of the facility and obtained copies of pertinent information which include but not limited to Physician’s Report dated on 09/28/23, Admission Agreement dated on 09/30/23, Progress Notes from 02/21/24 to 02/26/24, related to the complaint.
Continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
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 4
Control Number 31-AS-20240312124123
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: BROOKDALE CHATSWORTH
FACILITY NUMBER: 191221435
VISIT DATE: 03/12/2025
NARRATIVE
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No updated resident appraisal observed. LPAs conducted interviews with the Administrator and nine (9) out of fourteen (14) residents, who were able to communicate. On 03/21/24, LPAs Panushkina and Ngo-Castanega along with the Investigator, Jose Santana, from the Investigation Branch conducted a subsequent visit to interview R1.

Investigator Santana, conducted interviews with, Resident #1/R1 (on 03/21/24, 3/29/24, 4/3/24 and 5/1/24), R2 (on 05/01/24), R3 (on 03/27/24), R1's Social Worker and Case Manager (on 03/19/24), Primary Care Physician (on 03/28/24). On 3/22/2024 IB subpoenaed R2 records from LASD Records and Identification Bureau. On 3/27/2024, IB also subpoenaed R1's medical records from 2/20/2024 – 3/27/2024.

Allegation: Resident was sexually abused by another resident in care.

The investigation findings revealed that in the morning of 02/20/24 R2 entered the room of R3 and asked to inappropriately touch R3. The facility became aware of the incident but failed to address the matter of R2 at that time. As a result, R2 then entered R1’s apartment on the afternoon of 02/21/24 and sexually assaulted R1. Although, during the interview with the Investigator, conducted on 03/29/2024, the Administrator denied knowing that R1’s allegation included actual touching, it was reported by a facility’s MedTech on 2/22/2024 and was documented on the SOC341 on 2/21/2024. The facility again failed to follow Brookdale’s Abuse Policy where it indicated the following: “Brookdale is committed to maintaining a safe environment for clients, visitors and associates. Allegations of abuse, neglect or exploitation should be treated seriously and be reported to the Administrator or the supervisor on duty for investigation and follow-up. Upon receipt of an allegation of abuse, neglect or exploitation, the Administrator or designee should conduct a confidential internal investigation of the incident within 24 hours. In the event of suspected rape or sexual abuse, the facility is to develop a plan as soon as possible to protect the suspected victim. The suspected victim should have a medical examination. Evidence or potential evidence should be preserved… The agency should contact an agency or individual trained in sexual abuse to interview the client and provide counseling…” Had the facility investigated the 2/20/2024 incident, there is a possibility that the 2/21/2024 incident could have been prevented. Furthermore, the facility did not notify R1 who his/her perpetrator was, although, R2 has since departed the facility. Instead, the facility did ask R1 to not discuss the incident with other residents. Therefore, based on interviews and information gathered during this investigation, this allegation is Substantiated. Continue on LIC9099-C
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 31-AS-20240312124123
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: BROOKDALE CHATSWORTH
FACILITY NUMBER: 191221435
VISIT DATE: 03/12/2025
NARRATIVE
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A $500 immediate civil penalty is assessed today for a violation resulting in sexual abuse to R1. The Licensee/Executive Director were informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(f).

Exit interview conducted.
Civil penalties assessed and appeal rights explained.
Report reviewed, signed, and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 31-AS-20240312124123
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: BROOKDALE CHATSWORTH
FACILITY NUMBER: 191221435
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/13/2025
Section Cited
CCR
87468.1(a)(1-3)
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Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities for the elderly… (1) To be accorded dignity… (2) To be accorded safe, healthful and… (3) To be free from punishment, humiliation, intimidation, abuse…
This requirement is not met as evidenced by:
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Administrator is no longer working at this facility. Current Administrator agreed to provide a vendorized training to all staff regarding this section. Administrator will submit the name, license number and a scheduled training date.
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Based on interviews , record reviews and review of facility policy the licensee did not comply with the section cited above by not investigating 02/20/24 incident which could prevent R1 being sexually assaulted by R2 on 02/21/24. This posed an immediate health and safety risk or personal rights risk to persons in care.
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 Copy of certificates will be submitted upon completion. An immediate civil penalty in the amount of $500 is issued.
Type A
03/13/2025
Section Cited
CCR
87405(d)(1-2)
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Administrator-Qualifications and Duties: The Administrator shall have the knowledge of the requirements for providing care and supervision... The administrator shall also have the knowledge of and ability to conform to applicable laws, rules and regulations.
This requirement is not met as evidenced by:

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Administrator is no longer working at this facility. Current Administrator agreed to provide a vendorized training to all staff regarding this section. Administrator will submit the name, license number and a scheduled training date. Copy of certificates will be submitted upon completion
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Based on interviews the Administrator did non comply with the section sited above by not following the facility’s Abuse Policy to hire a neurologist for R1 after the incident. This posed an immediate health and safety risk or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC9099 (FAS) - (06/04)
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