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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197601489
Report Date: 10/31/2024
Date Signed: 10/31/2024 03:19:29 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/11/2024 and conducted by Evaluator Trevor Byrne
COMPLAINT CONTROL NUMBER: 29-AS-20240311142503
FACILITY NAME:CARRIE'S BOARD AND CAREFACILITY NUMBER:
197601489
ADMINISTRATOR:CARRIE ACOSTAFACILITY TYPE:
740
ADDRESS:8430 COLBATH AVENUETELEPHONE:
(818) 893-7619
CITY:PANORAMA CITYSTATE: CAZIP CODE:
91402
CAPACITY:6CENSUS: 4DATE:
10/31/2024
UNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Carrie AcostaTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff member sexually abused resident in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Trevor Byrne conducted a subsequent complaint visit to deliver findings for the above allegation at 09:03 AM. LPA met with facility staff and explained the reason for the visit. The facility Administrator Carrie Acosta was contacted via telephone call and arrived to the facility at 09:27 AM entrance interview conducted.

On 03/11/2024, the Department received a complaint regarding an allegation that a staff member sexually abused resident in care. It was alleged that facility Staff #1 (S1) sexually abused Resident #1 (R1) while changing their briefs and had asked R1 for a semen sample. The complaint was referred to the Community Care Licensing Investigations Branch (IB) and assigned to Investigator Olivia Spindola.

Continued on LIC 9099C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Trevor ByrneTELEPHONE: 747-444-6104
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024
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 3
Control Number 29-AS-20240311142503
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: CARRIE'S BOARD AND CARE
FACILITY NUMBER: 197601489
VISIT DATE: 10/31/2024
NARRATIVE
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On 03/13/2024, from 10:26 AM to 11:32 AM, Licensing Program Analyst (LPA) Emily Peraldi, conducted an unannounced 10-day initial complaint visit to the facility. At 10:26 AM, LPA Peraldi met with facility staff and explained the reason for the visit. At 10:50 AM, Administrator Carrie Acosta arrived at the facility. The LPA informed the Administrator that the Department received a complaint on 03/11/2024 and a referral was made to Community Care Licensing Division's (CCLD) Investigation Branch (IB). At 10:42 AM, the LPA, along with staff conducted a physical plant tour. At 11:00 AM, the LPA requested copies of pertinent documents. At 10:55 AM, the LPA conducted an interview with the Administrator.

On 04/11/2024 and 04/12/2024, Investigator Spindola conducted interviews with the Administrator and the Reporting Party (RP). The investigator was informed by the facility Administrator that R1 had passed away on 03/24/2024 due to complications with kidney failure and prior to R1’s death, they required dialysis treatments three (3) times per week. The facility Administrator informed the Investigator that they had conducted an investigation into S1’s sexual abuse of R1 but did not find any evidence to support the allegation. The Administrator added that R1 did not like to be cleaned up prior to being taken to dialysis. The interview with the Reporting Party (RP) revealed they reported the possible sexual abuse of R1 after R1 complained about it. The RP also stated they were aware that R1 did not liked to be cleaned or changed by staff.

During today’s visit on 10/31/2024 LPA Byrne interviewed residents, facility staff, the facility Administrator, and S1 between 09:27 AM and 11:55 AM. Additionally the LPA conducted a physical plant tour and obtained copies of documents pertinent to the investigation. LPA Byrne interviewed three (3) Residents. Resident #2 (R2) is newer to the facility and had not had any interactions with R1 or S1. Resident #3 (R3) and Resident #4 (R4) have been at the facility for almost four (4) years. Both R3 and R4 knew R1 and S1. Both R3 and R4 stated that S1 was nice. R3 stated that S1 had helped them change and shower and never had any issues with S1 previously. LPA Byrne interviewed two (2) staff members. Staff #2 (S2) has worked at the facility for 4 years. S2 stated that S1 stopped working at the facility 4-5 months ago. S2 stated that S1 was a good worker and had good interactions with the facility’s residents. S2 stated that R1 did not like to be changed by facility staff. S2 confirmed that they were aware of R1’s complaint that S1 has touched them inappropriately but stated that R1 would often say things to staff that were not true. Staff #3 (S3) was newer to the facility and had not had any interactions with R1 or S1.

Continued on LIC 9099C.
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Trevor ByrneTELEPHONE: 747-444-6104
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20240311142503
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: CARRIE'S BOARD AND CARE
FACILITY NUMBER: 197601489
VISIT DATE: 10/31/2024
NARRATIVE
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 LPA interviewed the facility Administrator. The facility Administrator confirmed that S1 no longer works for the facility. The Administrator stated that the reason S1 was no longer working at the facility was due to an altercation between S1 and S2 and not related to their job performance. The Administrator confirmed that they were aware of R1’s allegation against S1. The Administrator confirmed that R1 did not like being changed by staff but stated that it was necessary prior to R1 attending dialysis due to R1’s incontinence. The Administrator denied S1 ever acting inappropriately towards the facility’s residents. LPA interviewed S1 via telephone call. S1 confirmed that they are no longer working at the facility. S1 confirmed that they knew R1 and had assisted them with changing, using the bathroom, and showering in the past. S1 denied having ever touched R1 inappropriately. S1 denied ever having asked R1 to produce a semen sample. S1 denied abusing R1. LPA Byrne reviewed R1’s file which revealed that R1 had multiple diagnoses that required dialysis visits three (3) times per week. Based on interviews and record review there is insufficient evidence to support the allegation that a staff member sexually abused a resident in care. Although the allegation may have happened or is valid there is not sufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted. A copy of the report was provided
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Trevor ByrneTELEPHONE: 747-444-6104
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3