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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610342
Report Date: 03/06/2025
Date Signed: 03/06/2025 03:52:28 PM

Document Has Been Signed on 03/06/2025 03:52 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:STAR VIEW OLIVE VIEW UCLA CRTFACILITY NUMBER:
197610342
ADMINISTRATOR/
DIRECTOR:		SOWUNMI, GBENGAFACILITY TYPE:
772
ADDRESS:14139 BUCHER AVENUETELEPHONE:
(818) 290-5307
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY: 16CENSUS: 14DATE:
03/06/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:50 AM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced case management visit to this facility to follow up on a self-reported incident which occurred on 03/03/2025 at approximately 3:00 am. LPA was greeted by the Assistant Administrator Leigha Salcedo and the Administrator, Gbenga Sowunmi.

Client 1 (C1) reported to the LVN staff member (S1) they were sexually assaulted by their roommate Client #2 (C2). C1 was offered other sleeping accommodations. S1 prepared another room for C1. Another staff member (S2) conducted a health assessment on C1. The police were contacted and an officer conducted an interview with C1 and stated no evidence was found. C1 was sent to the hospital on 3/03/2025 for a medical examination.

During the visit, LPA reviewed the hospital discharge paperwork and C1’ s medical evaluation documentation. LPA Spaeth received copies of the documentation. LPA interviewed the Administrator and Assistant Administrator at 11:10 am until 11:25 am.

The facility conducted their own investigation and interviewed both clients egarding the alleged incident. C1 changed their story. C2 was sleeping in the room and was unaware

Continued on 809-C
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: STAR VIEW OLIVE VIEW UCLA CRT
FACILITY NUMBER: 197610342
VISIT DATE: 03/06/2025
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of what happened. To ensure the safety of both residents, C1 was moved to another room. The Administrator and Assistant Administrator confirmed staff are ensuring the safety of both residents is a priority.

LPA Spaeth toured the facility with the Administrator and Assistance Administrator at 11:30 am until 11:45 am. LPA did not observe any health or safety issues during this visit. LPA Spaeth interviewed C2 at 11:10 am until 11:15 am. C2 stated they have not had any issues with other clients within the facility.

Exit interview conducted. Copy of this report was given.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC809 (FAS) - (06/04)
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