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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191222665
Report Date: 12/10/2024
Date Signed: 12/10/2024 12:27:19 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
06/06/2023 and conducted by Evaluator Lorena Casillas
COMPLAINT CONTROL NUMBER: 31-AS-20230606153238
FACILITY NAME:ANTELOPE VALLEY CARE HOMEFACILITY NUMBER:
191222665
ADMINISTRATOR:BIBIANA, LARAFACILITY TYPE:
735
ADDRESS:40712 171ST STREET EASTTELEPHONE:
(661) 264-3341
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:6CENSUS: 4DATE:
12/10/2024
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Marie Lara BruTIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff spoke inappropriately to resident in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Lorena Casillas met with Administrator Marie Lara-Bru to deliver the final report, investigated by LPA Tuesday Cabiness. Administrator was informed of the reason for the visit.

Allegation: It was alleged that staff spoke inappropriately to Client #1 (C1) while in care.
To investigate the allegation, on June 14, 2023, from 12:00 p.m. to 3:30 p.m., the (LPA) conducted interviews and a physical plant inspection. Additional interviews with clients were conducted on December 03, 2024, from 5:30 p.m. to 5:45pm. During these interviews, clients reported that staff talk nicely to them. It was also revealed to LPA that there are no witnesses to staff speaking inappropriately to (C1) or any other clients while in the facility. An attempt to interview (C1) was unsuccessful, as (C1) now resides at another facility. Despite efforts, no additional information was provided to LPA regarding the allegation. Based on interviews, there is a lack of corroborating evidence to prove the allegation, therefore it is deemed Unsubstantiated at this time. Exit interview conducted and copy of report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024
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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