445202356-9-14-2023-26-AS-KHOS-D3AN2E-20240312100438

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 445202356
Report Date: 09/14/2023
Date Signed: 09/14/2023 11:16:31 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/21/2023 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20230421155833

FACILITY NAME:	MONTECITO MANOR		FACILITY NUMBER:	445202356
ADMINISTRATOR:	JOLENE SICLEY		FACILITY TYPE:	740
ADDRESS:	311 MONTECITO AVE.		TELEPHONE:	(831) 724-3055
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	85	CENSUS: 52	DATE:	09/14/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Jolene Sicley		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Resident was sexually abused while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Jolene Sicley, Administrator.

On 04/21/2023, the Department received a complaint with the above allegation. On 04/24/2023, the Department conducted an initial complaint investigation visit.

Resident R1 reported to R1’s Social Worker (SW) that around 04/15-16/2023 at around 02:00 AM to 03:00 AM, two Hispanic males sexually assaulted R1.

On 05/11/2023, the Department interviewed R1 regarding being sexually assaulted by two male staff at the facility. R1 disclosed that the staff did not penetrate R1, but rather touched R1 all over R1’s body.

See LIC9099-C for more information. Page 1 of 2.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David Marrufo	TELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

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 2

Control Number 26-AS-20230421155833

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: MONTECITO MANOR	FACILITY NUMBER: 445202356
	VISIT DATE: 09/14/2023

NARRATIVE

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R1 did not want to elaborate further on what R1 meant by being touched all over. R1 stated that staff S1 was one of the two male staff who inappropriately touched R1.

Interviews with staff revealed statements consistent with R1 not being inappropriately touched by any staff. Male staff are not consistently scheduled and present at the facility during NOC shift from 11:00 PM to 07:00 AM. Staff S1, S2, and former staff S3 and S4 provided consistent statements of R1 not having any issues or acting afraid of them. Staff S1-S4 all denied inappropriately touching R1.

SW verified that R1 has a traumatic sexual assault history and may have dreamt of the sexual assault.

Based on information from interviews conducted with staff, and records reviewed, although the allegation listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is unsubstantiated.

No Deficiencies were cited under California Code of Regulations Title 22

This report was reviewed with Jolene Sicley and a copy of this report was provided.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David Marrufo	TELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2