197610309-4-15-2025-31-AS-TAGD-DG3SFE-20250425135014

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610309
Report Date: 04/15/2025
Date Signed: 04/15/2025 11:32:26 AM

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
11/20/2024 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20241120092547

FACILITY NAME:	VALLEY STAR OLIVE VIEW UCLA CRT		FACILITY NUMBER:	197610309
ADMINISTRATOR:	VICTORIA MELNIKOVA		FACILITY TYPE:	772
ADDRESS:	14119 BUCHER AVE		TELEPHONE:	(818) 290-5307
CITY:	SYLMAR	STATE: CA	ZIP CODE:	91342
CAPACITY:	16	CENSUS:	DATE:	04/15/2025
		UNANNOUNCED	TIME BEGAN:	09:44 AM
MET WITH:			TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Client was sexually assaulted while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit at this facility to deliver the findings for the above allegation. LPA met with Administrator Gbenga Sonwunmi and explained the reason for the visit.

On 11/20/24, a complaint was received by the Woodland Hills Adult and Senior Care Regional Office. The complaint was referred to and accepted as an assignment by Community Care Licensing Division’s Investigations Branch (IB) and assigned to IB investigator Edward Hector.

On 11/21/2024 at 8:55 AM, LPA Tan initiated the complaint visit. LPA interviewed administrator, staff and resident and obtained copies of the facility records relevant to the investigation. LPA also reviewed facility Closed Circuit Television (CCTV) footage.

(continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025

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-20241120092547

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: VALLEY STAR OLIVE VIEW UCLA CRT	FACILITY NUMBER: 197610309
	VISIT DATE: 04/15/2025

NARRATIVE

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(continued from LIC 9099)

During the course of the investigation, IB Investigator Hector interviewed the facility staff, Resident #1, Hospital staff on 12/06/24 between 1:00 PM PM to 4:00 PM. On 12/09/24, Investigator Hector attempted to obtain Los Angeles Police Department (LAPD) records but was told none exist.

Regarding the allegation that a client was sexually assaulted while in care, it was alleged that R1 was sexually assaulted at the facility. Investigator Hector’s interview with R1 on 12/06/24 at 3:18 PM, revealed that R1 denied being a victim of verbal or physical abuse at the facility and also denied being sexually abused by any male at the facility. LPA’s video surveillance footage review on 11/21/24 revealed that on the night before R1 hospitalization (11/17/24), there was no incident that could have been construed as an assault against R1.

LPA’s record review on 04/13/25 at 9:44 AM revealed that R1 has a psychiatric condition that could have caused R1’s allegation. Investigator Hector’s interview with Staff #1 (S1) on 12/06/24 at 1:12 PM, confirmed that R1 had multiple psychiatric conditions and probable abuse during younger years that could have contributed to R1’s personality. Further interview with S1, also revealed that prior to R1’s psychiatric hold or hospitalization, R1 was on fifteen (15) minutes staff check during wake hours.

Based on the information gathered during the course of the investigation, the allegation is deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025

LIC9099 (FAS) - (06/04)

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