198602675-8-29-2023-28-AS-TVAO-CVNU5R-20230914151709

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602675
Report Date: 08/29/2023
Date Signed: 08/29/2023 03:17:45 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
07/26/2023 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230726094142

FACILITY NAME:	JMO SERENITY		FACILITY NUMBER:	198602675
ADMINISTRATOR:	SANCHEZ, ELLERANNE		FACILITY TYPE:	735
ADDRESS:	20505 SHADOW MOUNTAIN RD		TELEPHONE:	(909) 957-5620
CITY:	WALNUT	STATE: CA	ZIP CODE:	91789
CAPACITY:	4	CENSUS: 4	DATE:	08/29/2023
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Alicia Federspiel, House Manager		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff sexually abused a client while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent complaint investigation for the allegation listed above. LPA met with House Manager, Alicia Federspiel, and explained the purpose of the visit.

On 7/27/23, LPA K. Ramirez conducted the initial investigation and toured the facility. The staff and client rosters were obtained as well as documentation pertaining to Client #1 and Staff #1 - #14. During the visit today, LPA Chan interviewed the Administrator, 4 Staff and 2 Clients.

The investigation revealed the following:
Regarding the allegation, Staff sexually abused a client while in care. It is alleged that Staff grabbed client's breasts and the incident happened several times. The Department of Social Services Investigations Branch Investigator, Christine Ferris, interviewed Client #1 (C-1) who denied anyone inappropriately touching or hurting client.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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 28-AS-20230726094142

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: JMO SERENITY	FACILITY NUMBER: 198602675
	VISIT DATE: 08/29/2023

NARRATIVE

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C-1 feels safe residing at the facility and admitted to sometimes saying things that are not true.

LPA Chan interviewed Administrator Sanchez who indicated that she was informed about this incident and immediately asked C-1. C-1 told the administrator that it was not true and said it out of anger. Per Staff interviewed, they have not witnessed any incident of sexual abuse and would report it right away if they see any abuse. Staff reported that C-1 had previously said things that are not true, and the behaviors are logged under the client’s behavior chart. Based on record review, the Individual Program Plan indicates the goal for C-1 is to “reduce incidents of making false and accusatory statements and learn more appropriate coping skills when angry or frustrated with staff." LPA interviewed 2 Clients today. One client enjoys living at the facility and feels safe. Client had not observed any staff inappropriately touching another client.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted with Alicia Federspiel. A copy of this report along with the appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

LIC9099 (FAS) - (06/04)

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