197610099-4-23-2022-31-AS-NMAN-CG3LPF-20220706085552

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610099
Report Date: 04/23/2022
Date Signed: 04/23/2022 10:18:41 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
05/11/2021 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20210511090535

FACILITY NAME:	WYNGATE VILLA GARDENS		FACILITY NUMBER:	197610099
ADMINISTRATOR:	ESPINAL, ALMA		FACILITY TYPE:	740
ADDRESS:	7634 WYNGATE STREET		TELEPHONE:	(818) 352-4270
CITY:	TUJUNGA	STATE: CA	ZIP CODE:	91042
CAPACITY:	68	CENSUS: 59	DATE:	04/23/2022
		UNANNOUNCED	TIME BEGAN:	08:27 AM
MET WITH:	Juan Rivas - Med Tech		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Resident was sexually abused while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to deliver final findings for the above allegation. LPA met with staff Juan Rivas who called the administrator and explained the purpose of the visit. The administrator designated Juan Rivas to sign the report.

On 05/11/21, LPA Smith conducted the initial visit. During the initial visit, LPA conducted physical plant tour at 12:00 PM and requested facility documents relevant to the investigation. On 07/15/21, LPA Pitz conducted subsequent visit and interviewed staff between 1:15 to 4:15 PM.

It was alleged by the Complainant that Resident #1 (R1) felt that R1 was abused at the facility while asleep. LPA Pitz’s interview with the administrator on 05/11/2021 at around 4:00 PM indicated that R1 had a history of false allegation about assault and abuse and was referred to Adult Protective Services and law enforcement via SOC 341. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2022

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-20210511090535

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: WYNGATE VILLA GARDENS	FACILITY NUMBER: 197610099
	VISIT DATE: 04/23/2022

NARRATIVE

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(continued from LIC 9099-C)

Police came to the facility to investigate with negative results. LPA's record review on 04/03/22 at around 3:30 PM documented that R1 had a diagnosis of Schizophrenia (Paranoid type) and a history or false allegations including unknown person(s) putting poison on R1’s food or person(s) trying to attack or harm R1. Further review also revealed that R1 was unreasonably delusional and refused to take psychotropic medication. LPA attempted to locate R1 since R1 did not come back to the facility upon release from hospitalization on 05/07/21, to no avail.

Based on the information gathered during the course of the investigation, there is insufficient information to support the allegation and therefore unsubstantiated at this time.

Exit interview conducted. Copy of this report issued

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2022

LIC9099 (FAS) - (06/04)

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