197608466-6-23-2021-29-AS-JAPL-C8LVZJ-20211109155250

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608466
Report Date: 06/22/2021
Date Signed: 06/23/2021 02:11:19 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
06/17/2020 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20200617142706

FACILITY NAME:	BELMONT VILLAGE ENCINO		FACILITY NUMBER:	197608466
ADMINISTRATOR:	DRACHENBERG, CYNTIA		FACILITY TYPE:	740
ADDRESS:	15451 VENTURA BLVD		TELEPHONE:	(818) 788-8870
CITY:	SHERMAN OAKS	STATE: CA	ZIP CODE:	91403
CAPACITY:	150	CENSUS: 107	DATE:	06/22/2021
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Cyntia Drachenberg		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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1. Resident was raped at the facility.
2. Resident was beaten at the facility.
3. Administrator threatened the resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent complaint investigation (#29-AS-202006171-42706) to deliver the findings for the above allegations. LPA met with Administrator Cyntia Drachenberg and explained the reason for the visit.

On 6/17/2020, the Department received a complaint alleging that Resident #1 (R1) had been raped and beaten by multiple facility staff and residents at the facility, starting after R1’s admission on 09/2019 through 04/2020. Community Care Licensing Division’s (CCLD’s) Investigations Branch (IB) Investigator Dennis Douglas was assigned to interview R1.

Investigator Douglas conducted an interview with R1 on 06/22/2020 regarding R1’s allegation of sexual and physical abuse during the time R1 was a resident at this facility. R1 explained to the investigator that “it could be 10 to 20 a night” that would enter R1’s room and rape R1. When asked if R1 could provide the names of the perpetrators, R1 stated that R1 had them all written down somewhere, but was unable to provide a list.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021

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 3

Control Number 29-AS-20200617142706

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: BELMONT VILLAGE ENCINO	FACILITY NUMBER: 197608466
	VISIT DATE: 06/22/2021

NARRATIVE

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When R1 was asked if R1 had ever been sexually assaulted prior to this recent allegation, R1 stated that R1 was raped at a hospital in 2016 by the hospital staff and surgeons.

When Investigator Douglas asked R1 again about R1’s most recent sexual assault, R1 stated that the administrator would bring the residents down to R1’s room and “line them up around the hall” so they could come into R1’s room and rape R1; that the administrator would “schedule” them. When asked if the perpetrators were male or female, R1 stated that they were both. R1 further noted that R1 contacted the local Ombudsman for assistance and that the Ombudsman raped R1 as well.

During the interview, R1 was focused on the alleged rape incidents only and did not provide any additional comments on the alleged physical abuse.

The Department received a similar complaint on 12/02/2019, which alleged that “Resident #1 (R1) was sexually abused while in care.” This complaint was referred to CCLD’s IB Investigator, Christine Ferris. Investigator Ferris visited the facility, obtained police reports, reviewed R1’s records and interviewed staff, relevant parties and residents. Investigator Ferris found that the allegation was unfounded, meaning, that the allegation was false, could not have happened and/or is without a reasonable basis.

Based on the investigation, there is insufficient evidence to support the claim that R1 was sexually abused and/or beaten while at the facility. Therefore, the allegations are deemed as Unsubstantiated at this time.

Exit interview was conducted, today's report and appeal rights were reviewed and issued. Signatures were obtained. Report was issued

Regarding the allegation: Failure to keep resident(s) free from punishment, humiliation, intimidation, or abuse.

It was alleged that Administrator threatened R1, the reporting party’s concern is that the Administrator allegedly threatened resident #1 (R1) by saying, “you are hallucinating and if you continue to make these claims, I will send you to Encino Mental Hospital”. R1 informed the reporting party that R1 was in the mental hospital for five days and they raped R1 there, as well.

To investigate this allegation, Licensing Program Analyst (LPA) Urena interviewed the facility administrator, facility staff and residents.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20200617142706

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: BELMONT VILLAGE ENCINO	FACILITY NUMBER: 197608466
	VISIT DATE: 06/22/2021

NARRATIVE

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At 3:15pm the LPA interviewed (five residents). Residents reported that they have never witness or heard about Administrator threatening residents. Administrator is cordial, respectful and approachable.

At 3:30pm the LPA interview staff. Staff reported that they have never heard of any residents being threatened by Administrator. Administrator is cordial, respectful and approachable.

At 4:15pm the LPA interviewed Administrator. The administrator stated that she never threatened R1, by the time of the allegation this time, R1 was not living at the facility, she had moved out.

Based on the investigation, there is insufficient evidence to support the claim that R1 was threatened by Administrator. Therefore, this allegation is deemed Unsubstantiated at this time.

Exit interview conducted, today's report and appeal rights were reviewed and issued. Signatures were obtained. Report was issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021

LIC9099 (FAS) - (06/04)

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