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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608442
Report Date: 05/28/2024
Date Signed: 05/28/2024 11:07:32 AM

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. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/17/2023 and conducted by Evaluator Brian Balisi
COMPLAINT CONTROL NUMBER: 29-AS-20231117155214
FACILITY NAME:SVS VAN NUYSFACILITY NUMBER:
197608442
ADMINISTRATOR:MAGDALENA GALVEZFACILITY TYPE:
775
ADDRESS:14547 ERWIN STREETTELEPHONE:
(818) 849-3021
CITY:VAN NUYSSTATE: CAZIP CODE:
91411
CAPACITY:45CENSUS: 18DATE:
05/28/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Magdalena GalvezTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Neglect / Lack of Supervision Leading to Sexual Abuse
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent complaint visit to deliver final findings for the above allegation. During today’s visit, LPA met with Magadelena Galvez and explained the reason for the visit.

On 11/17/2023, the Department received a complaint alleging possible neglect/lack of supervision resulting in the sexual abuse of a client. It was reported that on 11/16/2023, Client #1 (C1) went to the restroom, and then two other clients went into the restroom with C1. C1 ran out of the restroom screaming they were in pain and motioned to certain parts of their body. The complaint was referred to the Community Care Licensing (CCL) Investigations Branch (IB) and assigned to Investigator Dennis Douglas.

On 11/20/2023, from 2:52 p.m. to 4:30 p.m., LPA Balisi conducted an unannounced complaint visit. During the visit at approximately 3:00 p.m., the LPA toured the physical plant, interviewed staff, and reviewed and obtained copies of pertinent documentation relevant to the investigation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024
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 6
Control Number 29-AS-20231117155214
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: SVS VAN NUYS
FACILITY NUMBER: 197608442
VISIT DATE: 05/28/2024
NARRATIVE
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Continued from 9099
Investigator Douglas conducted interviews on 12/15/2023, at approximately 12:10 p.m., with the Van Nuys Police Department (VNPD) Detective; on 01/10/2024, from approximately 11:00 a.m. to 1:40 p.m., with SVS facility program director and staff; on 01/25/2024, at approximately 4:20 p.m., attempted to contact C1’s client representative; on 02/06/2024, at approximately 3:30 p.m., with C1’s client representative; on 02/08/2024, at approximately 1:15 p.m., with hospital emergency room nurse; on 02/15/2024, at approximately 3:00 p.m., with VNPD Detective; and on 02/26/2024, at approximately 1:20 p.m., with Client #2 (C2) and Client #3 (C3). In addition, the investigator reviewed Olive View Medical Center medical records, VNPD incident report, Sexual Assault Response Team (SART) report, and facility file documents related to C1.

A review of the Olive View Medical Center report for C1 indicated the admission date as 11/16/2023 and the discharge date as 11/18/2023. The reason for C1’s admission was listed as Developmental Delay, Anxiety, Depression, presented to the emergency room with urinary retention and altered mental status after experiencing possible sexual assault at the vocational school (SVS Van Nuys Adult Day Program).

During the course of the investigation, it was revealed that on the morning of 11/16/2023, C1 was on an outing at a nearby park with several other clients and two facility staff members. C1 went into a restroom at the park with two other clients, Client #2 (C2) and Client #3 (C3). Moments later, C1 ran out of the restroom crying and in distress. During the investigation, the staff members present at the park that morning were interviewed. They acknowledged C1 has never acted like that in the 11 years C1 has been a client at the facility. They stated they asked C1 if any of the other clients in the restroom did anything to C1. C1 stated “No.” Later that morning, C1 and C1’s Client Representative were transported to the emergency room by the facility program director. While at the hospital, it was discovered that C1 had excess urine accumulation in their kidneys that caused swelling of the kidney. This typically causes pain during urination. However, a sexual assault examination was conducted on C1. Per the exam, it was discovered that two abrasions were observed in C1’s anal canal. However, the size of the abrasions was not indicated in the exam report. Also indicated in the SART report, was that there was “no finding” following a physical examination of C1.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 29-AS-20231117155214
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: SVS VAN NUYS
FACILITY NUMBER: 197608442
VISIT DATE: 05/28/2024
NARRATIVE
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Continued from 9099-C

Based on all the information obtained during the course of the investigation, the Department concluded that there was insufficient evidence to substantiate the allegation. Therefore, the allegation “Neglect/Lack of Supervision Leading to Sexual Abuse” is deemed Unsubstantiated at this time.

Exit interview conducted, copy of this report issued.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
11/17/2023 and conducted by Evaluator Brian Balisi
COMPLAINT CONTROL NUMBER: 29-AS-20231117155214

FACILITY NAME:SVS VAN NUYSFACILITY NUMBER:
197608442
ADMINISTRATOR:MAGDALENA GALVEZFACILITY TYPE:
775
ADDRESS:14547 ERWIN STREETTELEPHONE:
(818) 849-3021
CITY:VAN NUYSSTATE: CAZIP CODE:
91411
CAPACITY:45CENSUS: 18DATE:
05/28/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Magdalena GalvezTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Facility staff did not follow reporting requirements.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent complaint visit to deliver final findings for the above allegation. During today’s visit, LPA met with Magdelena Galvez and explained the reason for the visit.
On 11/17/2023, the Department received a complaint alleging that facility staff did not follow reporting requirements for possible neglect/lack of supervision resulting in the sexual abuse of a client. It was reported that on 11/16/2023, Client #1 (C1) went to the restroom, and then two other clients went into the restroom with C1. C1 ran out of the restroom screaming they were in pain and motioned to certain parts of their body. The day program staff contacted C1’s client representatives but the police were never notified by the day program. The complaint was referred to the Community Care Licensing (CCL) Investigations Branch (IB) and assigned to Investigator Dennis Douglas.On 11/20/2023, from 2:52 p.m. to 4:30 p.m., LPA Balisi conducted an unannounced complaint visit. During the visit at approximately 3:00 p.m., the LPA toured the physical plant, interviewed staff, and reviewed and obtained copies of pertinent documentation relevant to the investigation.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 29-AS-20231117155214
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: SVS VAN NUYS
FACILITY NUMBER: 197608442
VISIT DATE: 05/28/2024
NARRATIVE
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Continued from 9099-A

Investigator Douglas conducted interviews on 12/15/2023, at approximately 12:10 p.m., with the Van Nuys Police Department (VNPD) Detective; on 01/10/2024, from approximately 11:00 a.m. to 1:40 p.m., with SVS facility program director and staff; on 01/25/2024, at approximately 4:20 p.m., attempted to contact C1’s client representative; on 02/06/2024, at approximately 3:30 p.m., with C1’s client representative; on 02/08/2024, at approximately 1:15 p.m., with hospital emergency room nurse; on 02/15/2024, at approximately 3:00 p.m., with VNPD Detective; and on 02/26/2024, at approximately 1:20 p.m., with Client #2 (C2) and Client #3 (C3). In addition, the investigator reviewed Olive View Medical Center medical records, VNPD incident report, Sexual Assault Response Team (SART) report, and facility file documents related to C1.

The investigation revealed that the facility submitted an incident report to Community Care Licensing (CCL) which indicated they contacted C1’s client representative and the North Los Angeles Regional Center (NLARC) but did not notify the local police of the suspected abuse. Further, hospital notes revealed that the facility staff contacted the program director after the 11/16/2023 incident occurred to report the incident and the concern of possible sexual assault. Based on the information obtained during the course of the investigation, the Department concluded that there was sufficient evidence to substantiate the allegation. Therefore, the allegation “Facility staff did not follow reporting requirements” is deemed Substantiated at this time.

Pursuant to Title 22, California Code of Regulations, the following deficiency is cited (refer to LIC 9099-D)
Exit interview conducted, appeal rights discussed, and a copy of this report issued.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 29-AS-20231117155214
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: SVS VAN NUYS
FACILITY NUMBER: 197608442
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/29/2024
Section Cited
CCR
82061(c)
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Any suspected physical abuse... that does not result in serious bodily injury of an elder or dependent adult shall be reported...within twenty-four (24) hours as required by Welfare and Institutions Code Section 15630(b)(1). This requirement is not met as evidenced by:
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The licensee agreed to submit a plan on how they will comply with mandated reporting requirements. Submit to CCL via email by EOD 05/29/2024.
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Based on records review, the licensee did not comply with the section cited above. The licensee failed to report suspected abuse to the local police department, which posed an immediate health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6