306004795-7-14-2023-22-AS-SSAS-CULV8L-20230811161255

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004795
Report Date: 07/14/2023
Date Signed: 07/14/2023 11:38:21 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/26/2023 and conducted by Evaluator Celine DePerio

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230526163012

FACILITY NAME:	WESTMINSTER VILLA		FACILITY NUMBER:	306004795
ADMINISTRATOR:	PATTY OSUNA		FACILITY TYPE:	740
ADDRESS:	13881 DAWSON STREET		TELEPHONE:	(714) 534-7880
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92843
CAPACITY:	200	CENSUS: 117	DATE:	07/14/2023
		UNANNOUNCED	TIME BEGAN:	08:53 AM
MET WITH:	Facility Administrator- Patty Osuna		TIME COMPLETED:	11:50 AM

ALLEGATION(S):

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Resident is being sexually abused while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Celine made an unannounced visit to the facility to deliver findings for the complaint received on May 26, 2023. LPA arrived at the facility and explained the purpose of today’s visit and was greeted by facility administrator (AD) Patty Osuna.

The complaint was investigated by the Department. Findings are based upon this investigation which included record reviews and interviews.

It was alleged that a resident was sexually abused while in care. During the interview on July 2, 2023, the resident (R1) made “delusional statements”, stating that R1 had been sexually assaulted while asleep, however R1 admitted to never observing anyone enter the room. R1 stated “I was violated” and added “they were doping me up”, but when asked about who was doing this to R1, R1 was unable to provide further information by stating “I don’t know”.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

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 22-AS-20230526163012

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: WESTMINSTER VILLA	FACILITY NUMBER: 306004795
	VISIT DATE: 07/14/2023

NARRATIVE

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Following R1’s statement, R1 began to report how there was no hot water in the facility, therefore was unable to take a shower for two months, then reported how the air conditioner filter was clogged and that R1 noticed furniture being moved. When redirected to provide additional information regarding the allegations about being violated, R1 answered “I’m not sure” and “I listen to my body, and it tells me things” then stated, “I’m blind and drugged”. R1 reported that R1’s oxygen tank was “used as a sex toy…that was full of semen…that was getting in R1’s mouth and nose”. Per R1’s caregiver, R1 had not been using the oxygen tank. It was inquired if R1 had ever been physically touched, to which R1 did not provide an answer. In addition, R1’s oxygen tank and ventilator were checked, and no substances were observed. R1 then disclosed that R1’s roommate was an “evil spirit” and that “evil spirits are after me”. R1 is diagnosed with schizophrenia and according to the Garden Grove police report, on May 26, 2023, it was stated that R1 was having a manic episode and was delusional. The police report also indicated that R1 refused to undergo a rape exam.

Further investigation was unable to be conducted due to R1’s refusal of undergo an exam, and there is no physical evidence or witnesses to corroborate R1’s allegation.

The allegation is deemed UNSUBSTANTIATED, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted with AD Osuna a copy of this report was provided and explained.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/26/2023 and conducted by Evaluator Celine DePerio

COMPLAINT CONTROL NUMBER: 22-AS-20230526163012

FACILITY NAME:	WESTMINSTER VILLA		FACILITY NUMBER:	306004795
ADMINISTRATOR:	PATTY OSUNA		FACILITY TYPE:	740
ADDRESS:	13881 DAWSON STREET		TELEPHONE:	(714) 534-7880
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92843
CAPACITY:	200	CENSUS: 125	DATE:	07/14/2023
		UNANNOUNCED	TIME BEGAN:	08:53 AM
MET WITH:	Facility Administrator- Patty Osuna		TIME COMPLETED:	11:50 AM

ALLEGATION(S):

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Resident was injected with a contaminated needle while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Celine made an unannounced visit to the facility to deliver findings for the complaint received on May 26, 2023. LPA arrived at the facility and explained the purpose of today’s visit and was greeted by facility administrator (AD) Patty Osuna.

The complaint was investigated by the Department. Findings are based upon this investigation which included record reviews and interviews.

It was alleged that the resident was injected with a contaminted needle while in care. LPA De Perio conducted interviews which consisted of staff, residents, and external parties. 8 out of the 8 interviews conducted did not corroborate with the allegation by denying of that facility staff injected a resident. LPA spoke with R1’s pharmacy on May 30,2023. The Pharmacy verified that R1 was not given any prescribed injections, therefore the facility staff would not have any possession of any injections and needles.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 22-AS-20230526163012

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: WESTMINSTER VILLA	FACILITY NUMBER: 306004795
	VISIT DATE: 07/14/2023

NARRATIVE

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LPA De Perio reviewed R1’s medication chart, hospitalization record, and conducted a tour of the facility medication room, and LPA De Perio did not observe any injections and needles for R1.

Based on the interviews which were conducted, review of documents obtained, and observations, the allegation was UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted with AD Osuna and a copy of this report was provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4