<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603968
Report Date: 01/09/2024
Date Signed: 01/09/2024 11:38:40 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,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/23/2023 and conducted by Evaluator Charmaine Linley
PUBLIC
COMPLAINT CONTROL NUMBER: 08-CR-20231023120327
FACILITY NAME:A.B. JESSIE POLINSKY CHILDREN'S CENTERFACILITY NUMBER:
374603968
ADMINISTRATOR:ROSAS, ELIZABETHFACILITY TYPE:
721
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:204CENSUS: 37DATE:
01/09/2024
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH: Elizabeth RosasTIME COMPLETED:
10:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff sexually abused minor in care
Staff conducted a medical physical without minor's consent
Staff threatened minor in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On January 9, 2024, at 10:20 am, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced at the facility and met with Elizabeth Rosas, Protective Services Program Manager, to discuss the investigative findings for the allegations noted above. LPA conducted an inspection of the facility on 10/25/2023 at 11:21 am and no deficiencies were observed. LPA Linley interviewed one client (C1) and two contracted medical professionals (RN and MA). LPA attempted to interview one physician (DR) and was unable to contact them despite multiple attempts. LPA reviewed the following documents during the investigation: Child History Report, Virtual Assessment Team (VAT) Screening Form, C1 Consent to Treat form, C1 Nursing Notes, C1 Medical Discharge Summary, and C1 Admission Physical Examination form, dated 12/14/2022.

On 10/23/2023, Community Care Licensing (CCL) received allegations that staff sexually abused minor in care, staff conducted a medical physical without minor's consent, and staff threatened minor in care. It was
***CONTINUED ON NEXT PAGE
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ann Valenzuela
LICENSING EVALUATOR NAME: Charmaine Linley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024
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 08-CR-20231023120327
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: A.B. JESSIE POLINSKY CHILDREN'S CENTER
FACILITY NUMBER: 374603968
VISIT DATE: 01/09/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
stated that a contracted medical professional threatened C1 to take an exam when C1 refused and then the
medical professional inappropriately touched C1 during the exam. Confidential interviews revealed conflicting statements. Thus, confidential interviews did not corroborate the allegations with a preponderance of evidence.

Based on confidential interviews and records reviewed the allegation that staff sexually abused C1 in care, staff conducted a medical physical without C1’s consent, and staff threatened C1 in care, which may have occurred, however, it is not supported or proven by the evidence. Therefore, the allegations are unsubstantiated at this time.

An exit interview was conducted, appeal rights explained, and a copy of this report was reviewed with Elizabeth Rosas. Due to printer malfunction, a copy of this report, LIC 811, and appeal rights will be emailed to the Administrator. A copy of this report will be placed in the facility file.
SUPERVISORS NAME: Ann Valenzuela
LICENSING EVALUATOR NAME: Charmaine Linley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2