197609628-4-7-2023-31-AS-NMAN-CS6QQK-20230525122225

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609628
Report Date: 04/07/2023
Date Signed: 04/07/2023 11:03:54 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., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/22/2023 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20230322165715

FACILITY NAME:	CORNERSTONE FACILITIES, LLC		FACILITY NUMBER:	197609628
ADMINISTRATOR:	ANDERSON MUNOZ		FACILITY TYPE:	735
ADDRESS:	504 W AVE H13		TELEPHONE:	(818) 687-3830
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93534
CAPACITY:	4	CENSUS: 4	DATE:	04/07/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Iris Stephens		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Resi wasidennt was sexually abused while in care

INVESTIGATION FINDINGS:

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On 4/07/2023, Licensing Program Analyst (LPA) Melissa Spaeth arrived at the facility to conduct an unannounced complaint investigation and present investigation findings. Upon arrival, LPA was greeted by caregiver. LPA stated the purpose of the visit.

Allegation - Resident was sexually abused while in care
.
LPA interviewed six staff members on 3/24/2023, 3/29/2023, and 3/30/2023 who stated never witnessed a staff member walk into a resident’s room and shut the door. All six staff members were told by Licensee to never enter a resident’s room and shut the door. The Administrator was interviewed on 3/28/2023 who also confirmed all staff have received instruction to never enter a resident’s room and shut the door. Administrator stated has never personally done this.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

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 31-AS-20230322165715

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: CORNERSTONE FACILITIES, LLC	FACILITY NUMBER: 197609628
	VISIT DATE: 04/07/2023

NARRATIVE

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LPA received an incident report dated 3/22/2023 from the Licensee which stated received a phone call from the Los Angeles Sheriff’s Department. The Deputy Sheriff stated resident reported was sexually abused by a staff member. The Deputy Sheriff concluded that the allegations were false because the resident stated was upset with the staff member. The Deputy Sheriff stated would not respond to the call.

Based on staff interviews, review of incident report regarding the alleged incident, and the Los Angeles Deputy Sheriff’s Office response to the incident, there is insufficient evidence to support the allegation. Therefore, the allegation is unsubstantiated.

Exit interview conducted and a copy of the signed report was given to the caregiver.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC9099 (FAS) - (06/04)

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