198602022-6-13-2024-11-AS-JHAD-D6CM6T-20240618092028

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602022
Report Date: 06/13/2024
Date Signed: 06/13/2024 11:30:55 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/14/2024 and conducted by Evaluator Alfonso Iniguez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240214124146

FACILITY NAME:	HALLDALE MANOR		FACILITY NUMBER:	198602022
ADMINISTRATOR:	BUSTOS, GLENDA		FACILITY TYPE:	740
ADDRESS:	23438 HALLDALE AVENUE		TELEPHONE:	(310) 533-7364
CITY:	HARBOR CITY	STATE: CA	ZIP CODE:	90710
CAPACITY:	6	CENSUS: 5	DATE:	06/13/2024
		UNANNOUNCED	TIME BEGAN:	09:04 AM
MET WITH:	Virginia Romano/Facility Staff		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff sexually abused resident

INVESTIGATION FINDINGS:

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On 6/13/2024 LPA Alfonso Iniguez conducted a subsequent unannounced complaint visit. LPA Iniguez met with Virgina Romano /Facility Staff. LPA explained the purpose of this visit.

Investigation Consisted of: On 2/15/24, LPA obtained and reviewed the following documents: Resident’s roster, Personnel roster,(R#1-R#3) admissions agreement, (R#1-R#3) Identification and Emergency Information, (R#1-R#3) Physicians Report for Residential Care Facilities for the Elderly, (R#1-R#3) Needs and Services Plan, (R#1-R#3) Medication Administration Records (MARs), January 2024, and (R#1)'s medical record dated 12/11/2023. On 2/15/24, the complaint investigation was referred to the Community Care Licensing Investigation Branch (IB) and assigned to investigator Hiedy Bendana. IB Investigator Bendana conducted the following interviews and documentation gathered: On 3/15/24 Witness 4 (W#4), On 2/29/24 Administrator Interview(A#1) and Facility Staff (S#1), On 3/11/24 Witness 1 Interview (W#1) and Witness 2 (W#2), On 3/12/24 Interview with Witness 3 (W#3) and copy of Los Angeles Police Department Investigative Report dated 2/14/24. On 6/1324, LPA Iniguez interviewed (R#1-R#6).

Evaluation Report continues LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024

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 4

Control Number 11-AS-20240214124146

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: HALLDALE MANOR	FACILITY NUMBER: 198602022
	VISIT DATE: 06/13/2024

NARRATIVE

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Investigation Revealed the Following:

Allegation: Staff sexually abused resident

The details of the complaint alleged that facility staff sexually abuse a resident while in care.

During the records review, LPA Iniguez reviewed the following: IB Investigation dated 3/14/24 and Los Angeles Police Department Investigative Report dated 2/20/24.

The Los Angeles Police Department Investigative Report states that on 2/14/2024, Officer received a radio call about a battery investigation at 13438 Halldale Ave, Harbor City, CA 90710. Upon arrival, Officer met with (R#1), a resident of Halldale Manor. (R#1) stated that shortly after moving into the residence at approximately 2000 hours, (R#1) lay in bed. (R#1) woke up and could not move their arms or legs. (R#1) said a caregiver (later identified as (S#1)) entered their bedroom and walked over to them. (R#1) stated that (S#1) grabbed their right arm and placed their hand on (R#1)’s genitals; (S#1) then bent down and put their head on (R#1)’s genitals. (R#1) said (S#1) took a deep breath through their nose.

Officer spoke with (S#1), who is employed as a caregiver at the facility. (S#1) stated they lived at the facility and were there 24 hours a day. (S#1) denied ever sexually battering (R#1). Also, (S#1) stated that approximately two weeks prior, (R#1) laid in bed and called them inside. (S#1) could not understand what (R#1) said, (S#1) bent over to hear (R#1). (S#1) reported (R#1) pushed (S#1)’s shoulders away; that was the only physical contact they had. (S#1) stated they never had any eye injuries, nor did they go to the hospital.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20240214124146

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: HALLDALE MANOR	FACILITY NUMBER: 198602022
	VISIT DATE: 06/13/2024

NARRATIVE

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Officer spoke with (S#2), who is also a live-in caregiver. (S#2) stated the only physical altercation was when (R#1) tried to speak with (S#1), and (R#1) pushed (S#1) away. (S#2) said (S#1) has not hurt their eyes at work.

On 2/20/2024, the City Attorney rejected this case due to lack of sufficient evidence.

On 2/29/24, during an Interview conducted by Investigator Bendana of the Investigations Bureau with the Facility Administrator (A#1). (A#1) denied the allegation and stated that (R#1) never reported being touched inappropriately by (S#1). Moreover, (A#1) reported that (R#1) was no longer a resident at the facility, (A#1) stated that (R#1) discharged themselves from the Veterans Affairs (VA) hospital.

On 2/29/24, during an Interview conducted by Investigator Bendana of the Investigations Bureau with Facility Staff (S#1). (S#1) denied the allegation and denied touching (R#1) inappropriately.

On 2/29/24, Investigator Bendana of the Investigations Bureau was unable to locate resident 1 (R#1), (R#1) was no longer a resident at the facility.

On 6/13/2024, Licensing Program Analyst-LPA Alfonso Iniguez was unable to interview (R#1) at the facility, (R#1) left the facility on 2/19/24. LPA contacted Veterans Affairs (VA) case worker (W#3) on 6/11/24 but he was unable to contacted him by phone, LPA left o voicemail.

During interviews with residents (R#2-R#6), (5) out of (5) stated that the facility staff helps them with their basic needs, and they have never been sexually abused by facility staff. Also, (5) out of (5) residents stated that they feel safe living here.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20240214124146

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: HALLDALE MANOR	FACILITY NUMBER: 198602022
	VISIT DATE: 06/13/2024

NARRATIVE

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On 3/11/24, during an Interview conducted by Investigator Bendana of the Investigations Bureau with a Detective from the Los Angeles Police Department (W#1). (W#1) stated that the case was closed. The city attorney rejected the case because the allegation of sexual assault by facility staff lacked sufficient evidence.

On 3/12/24, during an Interview conducted by Investigator Bendana of the Investigations Bureau with Witness 3 (W#3), (W#3) stated that he was a registered nurse at the Veterans Affairs (VA) Hospital in Long Beach. (W#3) reported (R#1) was treated at the mental clinic. (R#1) missed last week’s appointment. Also, (W#3) stated that he was unable to provide (R#1)’s address, the contact information for (R#1)’s case manager or social worker, and (R#1)’s psychiatrist’s contact information. In addition, (W#3) said that if legal cleared the release of information, he would contact Investigator Bendana.

On 6/11/24, Licensing Program Analyst-LPA Alfonso Iniguez contacted (W#3) via telephone to inquired about the whereabouts of (R#1) ;(W#3) did not answer the phone, so LPA Iniguez left a voice message.

During this investigation, LPA did not find sufficient evidence to support the above-mentioned allegations.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, and a copy of the Complaint Report was given to Virginia Romano/Facility Staff.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024

LIC9099 (FAS) - (06/04)

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