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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609782
Report Date: 10/20/2022
Date Signed: 10/21/2022 10:39:37 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
07/06/2022 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20220706114905
FACILITY NAME:CARRIES CARE VILLAFACILITY NUMBER:
197609782
ADMINISTRATOR:ACOSTA, MARK RYANFACILITY TYPE:
740
ADDRESS:12550 BURTON STTELEPHONE:
(818) 767-4503
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY:6CENSUS: 5DATE:
10/20/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Carrie AcostaTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Facility staff inappropriately touched resident.
Facility staff yell at resident.
Facility does not provide adequate meal service.
Facility does not provide nutritious meals.
INVESTIGATION FINDINGS:
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On 10/20/2022, Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent complaint visit to deliver findings for the above allegation. LPA Urena was greeted by staff. Staff contacted met with administrator Carrie Acosta via phone. Administrator arrived at 10:20 a.m., and the LPA explained the reason for the visit.
On 07/06/2022, the Department received a complaint regarding an allegation of sexual abuse. It was alleged that Staff #1 (S1) inappropriately touched Resident #1 (R1). On 04/09/2022, R1 contacted law enforcement to report that R1 was assaulted by S1. R1 stated that S1 grabbed R1’s genitals from behind. The complaint was referred to the Community Care Licensing Investigations Branch (IB) and assigned to Investigator Heidy Bendana.
On 07/08/2022, from 11:25am to 3:00pm, Licensing Program Analyst (LPA) Sandra Urena conducted the initial 10-day complaint visit. LPA Urena met with the Administrator, Carrie Acosta, and explained the reason for the visit. mnContinues on LIC 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
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 4
Control Number 29-AS-20220706114905
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: CARRIES CARE VILLA
FACILITY NUMBER: 197609782
VISIT DATE: 10/20/2022
NARRATIVE
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The LPA and the Administrator conducted a brief tour of the facility. The LPA conducted a record review, and interviewed staff, residents, and responsible parties from 11:50am to 2:25pm. The LPA determined further investigation was needed.
On the allegation of 'Facility staff inappropriately touched resident'. On 07/19/2022, Investigator Bendana conducted interviews with R1, the Administrator, and Resident #2 (R2); and on 08/26/2022, with R1’s resident representative.

On 08/10/2022, Investigator Bendana reviewed the Los Angeles Police Department (LAPD) call for service report. The report stated that on 04/09/2022 at 12:41pm, officers arrived at the facility to respond to R1’s allegation that S1 grabbed R1’s genitals. The officers spoke with R1, S1, and witnesses; and, with R1’s resident representative, who stated R1 suffers from mental illness. The responding officer’s report stated the investigation revealed no crime occurred and the touching of R1’s genitals was accidental.

Information obtained through Investigator Bendana’s interviews found that R1 stated they were standing between the dining table and window when S1 stood up from the dining chair and grabbed R1’s genitals. The Administrator stated that S1 reported the incident immediately and the Administrator then called the police to investigate. Based on the incident accounts and police officers’ investigation, the officers determined no crime occurred and that S1 accidentally touched R1’s genitalia while standing up from the chair and walking by R1. There have been no prior incidents of inappropriate touching at the facility. R1 stated they have “never” seen S1 inappropriately touch others before. R1 reported that S1 had previously assisted R1 in the shower and “never” inappropriately touched R1. R2 stated they have not witnessed S1 touch anyone inappropriately and has not heard S1 make inappropriate comments. R1’s resident representative stated R1 tends to lie and previously made false “sexual assault” allegations in a different facility where R1 “imagined” someone was going to sexually assault them. R1’s resident representative does not believe R1 was sexually assaulted by S1. The photograph of the dining table overlooking the front yard shows the proximity of the dining table, chair and available standing room being minimal which could have caused S1 to accidentally brush their hands on R1’s genitals.

Based on the information obtained and statements made, the Department does not have sufficient evidence to support the above allegation. Therefore, the above allegation is deemed Unsubstantiated at this time.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20220706114905
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: CARRIES CARE VILLA
FACILITY NUMBER: 197609782
VISIT DATE: 10/20/2022
NARRATIVE
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On the allegation 'Facility staff yelled at resident'. It is the concern of the Reporting Party (RP) that the administrator yelled at residents, and stated that the administrator bullies residents by saying if they do not like living there then they can move. To investigate the allegation, LPA Urena conducted residents' interviews, and interviewed the administrator. The residents' interviews revealed that staff are helpful, and have not experienced being bullied by any staff or administrator. They are happy with the services the staff and the administrator provide. Staff clean the residents' rooms everyday, and help with showers as needed. The R1's representative reported that they know facility staff to be courteous, and respectful. They understand the R1's diagnosis may contribute to the allegation of staff yelling at them.

Based on the information obtained and statements made, the Department does not have sufficient evidence to support the above allegation. Therefore, the above allegation is deemed Unsubstantiated at this time.

On the allegation that the 'Facility does not provide adequate meal service'. The RP's concern is that the breakfast is served before 7a.m., and residents do not always want to eat that early. The LPA reviewed the meal schedule, and interviewed the administrator, and residents about the meal schedule. The interview with the administrator revealed that breakfast is served from 6:30 a.m. to 7:00 a.m., lunch between 11:00 a.m. to 11:30 a.m., and dinner around 4:00 p.m. The residents' interviews revealed that they are used to the meal service schedule. They stated that there is always fresh fruit to eat or other snacks are available. The administrator stated that the meals have been served within this schedule for a while, and that the residents are used to eating at these times. There are times when certain residents wake up later than the usual breakfast time, and the staff try to accommodate the residents by reserving their meal on the side. The administrator added that the residents receive some of their medications with their meals to prevent stomach problems. The administrator stated that they will ensure that the breakfast meal is reserved for those residents that are not awake for breakfast, but added that it may disrupt residents eating habits. The LPA observed a supply of fresh fruit for six residents in a container on top of the dining room table. The interview with R1's representative revealed that they have witness meals being served, and that the meals are adequate, and that perhaps the meals are served early for most people, but understands that R1 has to have a meal with their medications, and stay on schedule to prevent relapses. The R1's representative stated that they know of at least one occasion when a meal was prepared by staff, specially for the R1.
Continues on LIC 9099C...
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 29-AS-20220706114905
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: CARRIES CARE VILLA
FACILITY NUMBER: 197609782
VISIT DATE: 10/20/2022
NARRATIVE
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Based on the information obtained and statements made, the Department does not have sufficient evidence to support the above allegation. Therefore, the above allegation is deemed Unsubstantiated at this

On the allegation of 'Facility does not provide nutritious meals'. The RP's concern is that residents do not receive an adequate amount of protein, and that the facility serves mostly carbs and "no roughage." To investigate the allegation the LPA interviewed residents, staff, and reviewed the meal menu. The residents' interviews revealed that the menu includes such foods as chicken, sandwiches, salads with cucumber, corn peas, beans, and that there is plenty of fresh fruit available on the dining room table, to eat as they like. The LPA observed that the lunch served on the day of the visit was chicken adobo, corn and rice. The administrator and staff interview revealed that they try to serve a variety of foods every day of the week. The LPA observed the refrigerator, freezer, and pantry to have sufficient amount of foods, and a variety of foods for preparation as well.

Based on the information obtained and statements made, the Department does not have sufficient evidence to support the above allegation. Therefore, the above allegation is deemed Unsubstantiated at this time.



No citations were issued. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4