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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603165
Report Date: 10/09/2024
Date Signed: 10/10/2024 02:22:57 PM


Document Has Been Signed on 10/10/2024 02:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:GLEN PARK AT VALLEY VILLAGEFACILITY NUMBER:
197603165
ADMINISTRATOR:MARILOU MENDOZAFACILITY TYPE:
740
ADDRESS:5527 LAUREL CANYON BLVDTELEPHONE:
(818) 769-6626
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY:100CENSUS: 42DATE:
10/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:David AguinigaTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA), Valeria Conway, conducted a subsequent Case Management - Incident visit to deliver findings for the above allegation. LPA met with Administrator, David Aguiniga and explained the reason for the visit.

On 01/29/2024, the Department received a Report of Suspected Dependent Adult/Elder Abuse (SOC 341) from the facility regarding Resident #1 (R1). The report indicated that Resident #1 (R1) alleged that they were sexually assaulted by facility Resident #2 (R2). The case was referred to the Community Care Licensing Division (CCLD) Investigations Branch (IB) and assigned to Investigator Laarni Santiago.

On 01/31/2024, from 12:30 p.m. to 1:45 p.m., LPA Zabel Chochian responded to the facility to conduct a Case Management - Incidient visit in response to the SOC341 submitted by the facility administrator on 01/30/2024. The SOC341 report indicated that Resident #1 (R1) alleged that they were sexually assaulted two-weeks ago by another facility resident, Resident #2 (R2). The SOC 341 form was also submitted by the facility administrator to Adult Protective Services (APS), the local Long Term Care Ombudsman (LTCO) and local law enforcement. The administrator stated she was working on submitting the incident report to Community Care Licensing (CCL). During the visit, the LPA completed a brief physical plant tour, discussed the case with the administrators and obtained copies of R1 and R2’s records.

Continued on LIC 809-C
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria ConwayTELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:
DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: GLEN PARK AT VALLEY VILLAGE
FACILITY NUMBER: 197603165
VISIT DATE: 10/09/2024
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Continued from LIC 809-C

On 02/16/2024, at approximately 3:00 p.m., Investigator Santiago conducted an interview with the administrator; on 03/13/2024, from approximately 11:30 a.m. to 11:40 a.m., with administrator, assistant administrator, and staff; on 04/25/2024, from approximately 11:04 a.m. to 12:03 p.m., with resident, staff, and R1; and on 04/26/2024, from approximately 9:20 a.m. to 10:50 a.m., with residents, R2, and staff. In addition, facility file documents related to R1 and R2 were reviewed. Law enforcement interviewed and obtained statements from R1 and R2, however the police report and findings have not yet been received by the Department.

Information obtained from the Department’s investigation revealed that R1 reported that sometime in mid-January of 2024, R2 offered R1 a cigarette. When R1 moved R1’s wheelchair closer to R2’s wheelchair, R2 pulled R1 closer by wrapping R2’s leg around R1’s. R2 suggested it was the only way R2 could light R1’s cigarette. Subsequently, R2 placed R2’s hand over R1’s vagina and touched it. R1 said that R2 “scooped” (no penetration) R1’s vagina without R1’s consent. R1 repeatedly told R2 to “stop” and when R2 finally did, R2 asked R1 to go with R2 behind the dumpsters because there were “too many cameras.” R1 followed R2 and R2 asked if R1 could orally copulate R2 for money and R1 said “no.” R1 left the backyard patio and went to R1’s room. R1 later reported the incident to law enforcement and the administrator. R1 revealed that this was the first time R2 had ever touched R1 inappropriately. The administrator and staff began to closely supervise R2 and R1 to avoid any future encounter that would put R1’s safety at risk. This was corroborated by R1 when R1 told the investigator that staff had been keeping a close eye on them since the incident, and there had not been any new incidents since then. Furthermore, staff were all aware of keeping close supervision on R2 to ensure that R2 does not sexually or physically assault R1 or other residents.

Continued from LIC 809-C
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria ConwayTELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: GLEN PARK AT VALLEY VILLAGE
FACILITY NUMBER: 197603165
VISIT DATE: 10/09/2024
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Continued on LIC 809-C

R2 declined to be interviewed but refuted the claim that R2 touched or sexually assaulted any residents at the facility. Interviews with residents did not express any concerns about staff supervision. There were no witnesses to corroborate the incident between R2 and R1. Additional information gathered during the investigation revealed that there is a surveillance camera in the back patio where the alleged incident happened between R1 and R2. However, per the administrator, there were no footage found of them in the back patio. The Department found insufficient evidence to prove that the staff's neglect/lack of care and supervision led to the alleged incident.


Exit interview, copy of report given.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria ConwayTELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024
LIC809 (FAS) - (06/04)
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