197610101-10-17-2023-31-AS-NMAN-CWS2HE-20231019172436

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610101
Report Date: 10/16/2023
Date Signed: 10/17/2023 03:16:53 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
04/20/2023 and conducted by Evaluator Antonia Alvizar

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20230420091559

FACILITY NAME:	HAMLIN ELDER CARE		FACILITY NUMBER:	197610101
ADMINISTRATOR:	BIGORNIA, LIMA ROSE		FACILITY TYPE:	740
ADDRESS:	20300 HAMLIN ST.		TELEPHONE:	(818) 912-6289
CITY:	WINNETKA	STATE: CA	ZIP CODE:	91306
CAPACITY:	0	CENSUS: 0	DATE:	10/16/2023
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:			TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Resident was sexually abused while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Antonia Alvizar made an unannounced subsequent visit to the facility to deliver finding for the above noted allegation. At 12:30pm LPA arrived, facilty was vacant and under construction. LPA contacted Administrator, Lima Rose Bigornia via-phone and disclosed the reason for the visit. Administrator indicated that was in a meeting and not available today.

On 04/20/2023, Community Care Licensing Department (CCLD) received a complaint alleging that facility resident #1 (R1) was inappropriately touched by the facility staff #1 (S1).

The allegation was referred to Community Care Licensing Departments (CCLD) Investigation Bureau (IB) and the investigation was assigned to Senior Investigator (SI) Heidy Bendana.

On 04/21/2023 at approximately 10:00AM LPA Alvizar made an initial complaint visit to the facility. At 10:10AM LPA requested copies of R1’s Identification Information, Preplacement Appraisal, Physician Report, Unusual Incident Reports, Resident and Staff roster.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2023

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-20230420091559

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: HAMLIN ELDER CARE	FACILITY NUMBER: 197610101
	VISIT DATE: 10/16/2023

NARRATIVE

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Between 10:20AM -10:40AM, physical plant inspection was made to ensure that there are no immediate health and safety hazard affecting residents.

During investigation, on 05/15/2023, SI spoke with the police detective, who attended the facility to investigate R1’s sexual abuse incident. The case was closed due to inconsistent statement from the R1 and lack of evidence.

On 05/15/2023 SI requested and reviewed a police report regarding R1’s sexual abuse, notating that there was no evidence of sexual abuse. On 05/18/2023, SI spoke with R1 who indicated that while S1 was cleaning them, S1 touched R1’s private parts and he “would go deeper”. R1 was unable to describe how S1 would go deeper in R1’s private parts. Interviews of the staff conducted by SI on 05/18/2023, revealed that they have no staff with S1’s name. R1 was being cared for by the staff #4 (S4). The care includes incontinent care and bathing.

Overall investigation did not provide sufficient corroborating information and evidence to support the allegation. Therefore, based on observation, interviews and record review, the allegation is UNSUBSTANTIATED at this time.

Administrator approved for Caregiver, Florinda Murophy to sign report.

Exit interview was conducted and a copy of report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2023

LIC9099 (FAS) - (06/04)

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