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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601962
Report Date: 05/06/2024
Date Signed: 06/18/2024 11:51:03 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/28/2023 and conducted by Evaluator Nicol Wesley
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20231128110105
FACILITY NAME:SOUTHLAND LIVINGFACILITY NUMBER:
198601962
ADMINISTRATOR:TRAN, VICTORIAFACILITY TYPE:
740
ADDRESS:11701 STUDEBAKER ROADTELEPHONE:
(562) 406-7326
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:75CENSUS: 52DATE:
05/06/2024
UNANNOUNCEDTIME BEGAN:
11:32 AM
MET WITH:Michelle AdamsTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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9
Resident was sexually assaulted while in care.
INVESTIGATION FINDINGS:
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13
***This report serves as an amendment and supersedes the complaint investigation report dated 05/06/24. The purpose of the Amendment is to correct confidential. The findings remain as Unsubstantiated. ***

On 6/18/2024 LPA Baptiste conducted an unannounced visit to deliver findings on an amended complaint. During today’s visit LPA Baptiste met with Wellness Director Michelle Adams and Assistant Administrator Zach Miller and explained the reason for the visit.

On 5/6/2024 Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced subsequent visit to deliver findings for a complaint investigation for the allegation listed above. LPA met with Assistant Administrator Zach Miller and later met with Administrator Victoria Tran to discuss the purpose for today’s visit. (Report Cointued on 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024
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 2
Control Number 28-AS-20231128110105
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: SOUTHLAND LIVING
FACILITY NUMBER: 198601962
VISIT DATE: 05/06/2024
NARRATIVE
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***This report serves as an amendment and supersedes the complaint investigation report dated 05/06/24. The purpose of the Amendment is to correct confidential. The findings remain as Unsubstantiated. ***

During the initial inspection conducted by LPA Wesley. The following documents was obtained: staff roster, resident roster, Report information and victims bill of rights from Sheriff department, Admissions agreement for Resident #1(R1) and Resident #2 (R2), Medication review report for R1 and R2 and R1’s resident appraisal.

IB investigator Juan Lozano interviewed the Administrator, Wellness Director, Staff #1-#2, Resident #1-#5, and requested a copy of staff roster, and resident roster.

IB investigator Juan Lozano indicated R2 disclosed that they voluntary allowed R1 into their room to show them the refrigerator. According to R2, while R1 was inside of the room, for an unknown reason grabbed they tried to squeeze the right breast of R2 and kiss R2. R2 denied that they notified Southland Living Staff that was going to have R1 in the room. R1 denied the allegation stating they did not try to grab R2’s breast. This incident was reported several weeks after it allegedly happened.

Based on LPAs observation and interviews, the preponderance of evidence standard has not been met, therefore the above allegation is found to be Unsubstantiated.



A copy of this report was given to the Wellness Director and Assistant Administrator.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2