197606814-2-15-2022-31-AS-NGID-CCLRZK-20220317132803

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606814
Report Date: 02/15/2022
Date Signed: 02/15/2022 01:55:36 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
09/28/2021 and conducted by Evaluator Shira Stamps

COMPLAINT CONTROL NUMBER: 31-AS-20210928155600

FACILITY NAME:	PROJECT INDEPENDENCE		FACILITY NUMBER:	197606814
ADMINISTRATOR:	KATHLEEN MILLER		FACILITY TYPE:	775
ADDRESS:	43439 COPELAND CIRCLE		TELEPHONE:	(661) 948-8402
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY:	102	CENSUS: 34	DATE:	02/15/2022
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Jordan Williams, Counselor Program Manager		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Client was sexually assaulted while in care
Client caused injuries to another client while in care

INVESTIGATION FINDINGS:

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

On 02/15/22 at 1:30pm, Licensing Program Analyst (LPA) Shira Stamps conducted an unannounced subsequent complaint visit to deliver the findings regarding the allegations, “Client was sexually assaulted while in care” and “Client caused injuries to another client while in care.” Entrance interview conducted.

On 09/28/21, a complaint was received by the Woodland Hills Adult and Senior Care Regional Office. The complaint was referred to and accepted by Community Care Licensing Division’s, Investigations Branch. The investigation was assigned to Investigator Georgina Tallagua.

Continued...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022

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-20210928155600

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: PROJECT INDEPENDENCE	FACILITY NUMBER: 197606814
	VISIT DATE: 02/15/2022

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

On 10/07/21 LPA Shira Stamps and Angela Panushkina conducted a 24-hour complaint visit. LPAs collected personnel files, physician report, individual service plan, and background clearance for a new staff member. Interviews with clients, staff, and other witnesses which include but not limited to law enforcement were conducted by the Investigations Branch. Interview were conducted on 10/15/21; 10/28/21 and 11/04/21. Follow up interviews were conducted on 11/04/21; 11/09/21;11/16/21, and 12/08/21. Medical records were subpoenaed 11/04/21 and reviewed 12/08/21.

The investigation revealed, that based on interviews with witnesses and review of received and reviewed documentation, there was no inappropriate behavior observed between Client 1 (C1), Client 2 (C2), and Client 3 (C3) at any time when they attended the day program. No one observed C1 to have a black eye at any point when C1 attended the day program. C1 and C2 are in the same group and they are always supervised by staff. Staff stated C1 and C2 had very little interaction, and do not sit next to each other. C3 has left the program as of March 2020. One (1) out of three (3) clients interviewed stated no incident happened. One (1) out of three (3) clients stated they did not really talk to C1, and no sexual or physical assault occurred. Medical records revealed C1 was treated for a Urinary Tract Infection (UTI), no documentation of sexual assault. Statements and documents were collected as an incident report with local Sheriff’s Department. The case revealed,” no crime” and the case was closed. Therefore, due to lack of supporting evidence, the allegations, “Client was sexually assaulted while in care” and “Client caused injuries to another client while in care,” are deemed unsubstantiated.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2