197602143-5-8-2021-31-AS-MVAO-C54NR9-20210720104109

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602143
Report Date: 05/08/2021
Date Signed: 05/08/2021 06:20:08 PM

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
11/25/2020 and conducted by Evaluator Yelena Avetisyan

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20201125164925

FACILITY NAME:	HOME SWEET HOME II		FACILITY NUMBER:	197602143
ADMINISTRATOR:	ALFONSO DE LA CUESTA		FACILITY TYPE:	740
ADDRESS:	23788 VIA JACARA		TELEPHONE:	(661) 254-3336
CITY:	VALENCIA	STATE: CA	ZIP CODE:	91355
CAPACITY:	6	CENSUS: 5	DATE:	05/08/2021
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Alfonso DeLa Cuesta		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident 1 (R1) was sexually abused by Staff 1 (S1)

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

An unannounced subsequent complaint visit was conducted on 05/08/2021 by Licensing Program Analyst (LPA) Yelena Avetisyan. This investigation was conducted by Jose Santana, Investigator with Community Care Licensing Division’s Investigations Branch.

In regard to the allegation of sexual abuse, it was reported that S1 touched R1 inappropriately, undressed in front of R1 and took photos of R1 without clothing.

From 12/2/2020 to 2/24/2021, Investigator Santana conducted interviews with various individuals including the complainant, Administrator Alfonso De La Cuesta, Resident 1 (R1) and other facility residents, facility staff including staff 1 (S1), LASD detective, LTCO and R1’s Primary Care Physician and Neurologist.
On 12/29/2020 Investigator Santana conducted review of medical records from Facey Medical group which were subpoenaed on 12/4/2020. The records reviewed noted resident having a history of Parkinson’s disease, brain atrophy, and memory loss with intermittent hallucinations and lapses of confusion/sundowning.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Yelena Avetisyan	TELEPHONE: (818) 378-8120
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2021

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-20201125164925

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: HOME SWEET HOME II	FACILITY NUMBER: 197602143
	VISIT DATE: 05/08/2021

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

When interviewed by the Investigator and a Los Angeles Sheriff’s Department (LASD) Detective, R1 was unable to confirm the allegation, unable to name S1 as the perpetrator, and unable to identify S1 from a photo line-up. Medical records reviewed noted that R1 suffered from hallucinations and delusions at the time of her facility residence. When interviewed, facility residents did not express concerns with the care they received at the facility. Staff interviewed denied that S1 provided any personal care to any resident and maintained there was no instance of S1 being alone with R1. Based on the information obtained during the course of the investigation, the allegation that Resident 1 (R1) was sexually abused by Staff 1 (S1) is unsubstantiated at this time.

Exit interview conducted and copy of report emailed to the administrator.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Yelena Avetisyan	TELEPHONE: (818) 378-8120
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2