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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191222733
Report Date: 02/11/2022
Date Signed: 02/11/2022 02:03:06 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
09/24/2021 and conducted by Evaluator Wendell Smith
COMPLAINT CONTROL NUMBER: 31-AS-20210924163546
FACILITY NAME:VALLEY VILLAGE ADULT DEVELOPMENT CENTERFACILITY NUMBER:
191222733
ADMINISTRATOR:THOMAS, DONNAFACILITY TYPE:
775
ADDRESS:20830/20834 SHERMAN WAYTELEPHONE:
(818) 587-9455
CITY:CANOGA PARKSTATE: CAZIP CODE:
91306
CAPACITY:129CENSUS: 17DATE:
02/11/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Regina Arvizu-BrananaTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff inappropriately touched client
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced subsequent visit to finish investigation into the allegation above. LPA met with the administrator and explained the reason for this visit.

It is alleged that client #1 (C1) was touched inappropriately by staff # 1(S1). During the course of the investigation LPA conducted visits to the facility on 9/27/21 and 1/5/22. LPA conducted interviews with S1, facility staff, and R1’s family member. LPA also obtained copies of incident reports related to the incident. Information obtained from interviews reveal that approximately in August of 2021 C1 had some incidents where they were causing disturbances at the program and physically attacked S1 causing injury. C1 was then told they could not come back to program until a meeting could take place to help C1 with their behaviors. In between while C1 was not allowed at program C1 was calling the program several times a day and made verbal threats to S1 about harming S1 and their family. LPA was informed that S1 went to court and had a mediation with C1 and their family on 10/8/2021
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
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-20210924163546
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: VALLEY VILLAGE ADULT DEVELOPMENT CENTER
FACILITY NUMBER: 191222733
VISIT DATE: 02/11/2022
NARRATIVE
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LPA obtained a copy of a report and reviewed it. It stated that C1 was not allowed to come near the program or S1 and could not have any communication with the facility or staff. During the course of the investigation LPA attempted to interview C1 and their responsible party but LPA was refused those interviews. LPA also spoke with North Los Angeles Regional Center staff regarding the allegation. Information obtained from interviews did not reveal any inappropriate touching or interaction from S1 to C1. Based on information obtained through interviews this allegation is deemed Unsubstantiated at this time. There is insufficient information to state that C1 was touched inappropriately by S1.

Exit Interview conducted.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2