197608129-1-4-2024-29-AS-KLOZ-CZYMRB-20240130085000

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608129
Report Date: 01/03/2024
Date Signed: 01/04/2024 08:49:51 AM

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
08/24/2023 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20230824092613

FACILITY NAME:	RESIDENCES AT ROYAL BELLINGHAM, THE		FACILITY NUMBER:	197608129
ADMINISTRATOR:	LORI MCKAY		FACILITY TYPE:	740
ADDRESS:	12229 CHANDLER BOULEVARD		TELEPHONE:	(818) 980-2997
CITY:	VALLEY VILLAGE	STATE: CA	ZIP CODE:	91607
CAPACITY:	96	CENSUS: 94	DATE:	01/03/2024
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Lito Vitug		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Resident was inappropriately touched in a sexual manner by staff.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent complaint visit to deliver findings for the above allegation. LPA met with the Executive Director, Lito Vitug and explained the reason for the visit.

On 08/24/2023, the Department received a complaint regarding an allegation of Sexual Abuse. It was alleged that facility Staff #1 (S1) inappropriately touched Resident #1 (R1) in a sexual manner while assisting R1 in the shower. The complaint was referred to the Community Care Licensing Investigations Branch (IB) and assigned to Investigator Douglas Real to conduct interviews to determine if a full investigation was warranted.

Continues on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230824092613

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: RESIDENCES AT ROYAL BELLINGHAM, THE	FACILITY NUMBER: 197608129
	VISIT DATE: 01/03/2024

NARRATIVE

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On 08/29/2023, from 10:00am to 12:10pm, Licensing Program Analyst (LPA) Sandra Urena conducted an initial visit to investigate the allegation listed above. LPA Urena met with administrator Lori McKay and explained the reason for the visit. The LPA requested records pertinent to the investigation at 10:00am and interviewed the administrator between 10:30am and 11:40am. The LPA determined further investigation was needed prior to issuing the findings.

On 08/30/2023, from approximately 11:20am to 2:15pm, Investigator Real conducted interviews with R1 and S1; on 09/05/2023, from approximately 3:10pm to 4:30pm, with facility residents, and on 09/12/2023, at approximately 6:20pm, with the reporting party.

The interviews revealed that R1 did not disclose any sexual abuse; however, R1 reported S1 did not wear gloves while assisting R1 in the shower. S1 denied the allegation and reported they always wear gloves while showering residents. The residents who were interviewed reported all the facility employees wear gloves (S1 included) when assisting them in the shower. The reporting party advised that R1 disclosed that S1 did not wear gloves while assisting R1 in the shower but did not disclose any sexual abuse by S1.

The information obtained during the investigation revealed there was insufficient evidence to support the allegation occurred. Therefore, the Department has determined the allegation “Sexual Abuse – Resident was inappropriately touched in a sexual manner by staff” is deemed Unsubstantiated at this time.

Exit interview was conducted, a copy of the report was issued.

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

LIC9099 (FAS) - (06/04)

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