<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607495
Report Date: 07/21/2021
Date Signed: 07/21/2021 01:30:37 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. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/06/2021 and conducted by Evaluator Ashley Smith
COMPLAINT CONTROL NUMBER: 29-AS-20210106162312
FACILITY NAME:CHATEAU LE PETITE IIIFACILITY NUMBER:
197607495
ADMINISTRATOR:BELINDA DOLINSKYFACILITY TYPE:
740
ADDRESS:24312 CARIS STREETTELEPHONE:
(818) 981-5792
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:6CENSUS: 2DATE:
07/21/2021
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Dexter OlavarioTIME COMPLETED:
01:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff sexually assaulted resident resulting in resident developing an infection.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Ashley Smith conducted a subsequent complaint investigation to issue findings for the above allegation. The LPA spoke with staff Dexter Olavario and issued the findings.

On 1/06/2021, the Department received a complaint which alleged that staff sexually assaulted Resident #1 (R1), resulting in R1 developing an infection. Community Care Licensing Division’s Investigations Branch (IB) Investigator Edward Hector was assigned to the case. On 1/7/2021 at 1:00 p.m., LPA Aja Richardson conducted the initial visit and interviewed staff, request documents, and completed a physical plant tour at 1:30 p.m. Investigator Hector reviewed medical records and conducted the following interviews: interviewed a detective from the Los Angeles Police Department on 1/12/2021 at 12:21 p.m.; interviewed a family member for R1 on 1/26/2021 at 11:51 a.m.; interviewed facility staff on 1/26/2021 at 5:27 p.m., on 3/18/2021 at 4:32 p.m., on 3/23/2021 at 7:59 p.m. and at 8:18 p.m.; interviewed a physician whom evaluated R1 on 3/18/2021 at 12:42 p.m.; and, interviewed a representative from a wound care facility on 3/18/2021 at 1:11 p.m.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
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 29-AS-20210106162312
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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: CHATEAU LE PETITE III
FACILITY NUMBER: 197607495
VISIT DATE: 07/21/2021
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
Per the investigation, R1 resided at this facility from 10/24/2018 – 12/14/2020, and moved to Serenity Manor (Facility #197609888), where R1 resided from 12/14/2020 through 1/5/2021. It was alleged that upon being examined at Serenity Manor, R1 was discovered with ‘skin protrusions’ and abnormal skin growth on R1’s genitalia and R1’s mouth. As such, it was alleged that the presence of the abnormalities was a result of sexual assault from staff at this facility. Staff interviews revealed that whereas staff confirmed observing ‘bumps’ on R1’s genitalia, it was stated that it was observed since R1 was initially admitted to the facility. Staff stated that R1 was monitored by the hospice agency, whom never communicated concern about the presence of the bumps. Staff also confirmed speaking to hospice staff about the bumps, whom informed staff that there was no apparent issue. Furthermore, Investigator Hector identified that there was one male staff whom provided care for R1 in this facility, and interviews negated the claim that this staff sexually abused R1 or any resident at this facility. Other than changing R1 when R1 had a bowel movement, it was confirmed that the male staff would primarily provide care for R1 in the presence of other female care staff.

Interviews revealed that whereas it was initially alleged that R1’s condition was diagnosed as genital herpes, further investigation revealed contradictory information. R1’s Physician’s Report dated 12/10/2020 did not reveal information related to bumps, blisters, or herpes on R1’s genitalia. The physician whom completed R1’s Physician’s Report denied having any knowledge of R1 having genital herpes. Facility staff from Serenity Manor confirmed that an initial assessment was completed on R1 and that R1 was also assessed by a wound care nurse; however, staff denied receiving confirmation verbally or in writing of R1 having genital herpes. However, an additional assessment was conducted after R1 was observed with blisters in R1’s mouth and genitalia. Further review of the assessment conducted by a physician on 12/29/2020 noted that R1 was observed to have ‘4-5 round skin protrusions in the regular border’ of R1’s genitals. It was ultimately determined that the lesions in R1’s genital area was likely not an infection, either viral or fungal, and was possibly Verruca Vulgaris, which the physician identified Verruca Vulgaris as a type of genital wart.

Based on the investigation, there is insufficient evidence to support the claim of sexual assault against R1. There is no evidence of R1 being diagnosed with genital herpes, and there is no documented suspicion of sexual abuse. The Los Angeles Police Department conducted a separate investigation, in which it was further determined that the physician whom examined R1 on 12/29/2020 did not diagnose R1 with herpes, but rather, genital warts. The investigation was closed as an injury report. This allegation is deemed Unsubstantiated at this time. No deficiencies cited. Exit interview conducted. A copy of the report was issued.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2