445202401-9-10-2024-26-AS-KHOS-D9DN7T-20240923101317

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 445202401
Report Date: 09/10/2024
Date Signed: 09/10/2024 02:03:38 PM

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
05/08/2024 and conducted by Evaluator Christine Dolores

COMPLAINT CONTROL NUMBER: 26-AS-20240508140805

FACILITY NAME:	VALLEY HAVEN III		FACILITY NUMBER:	445202401
ADMINISTRATOR:	JOSEPHINE ARCILLA		FACILITY TYPE:	740
ADDRESS:	2266 CHANTICLEER AVE.		TELEPHONE:	(831) 818-8372
CITY:	SANTA CRUZ	STATE: CA	ZIP CODE:	95062
CAPACITY:	48	CENSUS:	DATE:	09/10/2024
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Josephine Arcilla		TIME COMPLETED:	02:05 PM

ALLEGATION(S):

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Staff sexually abused resident while in care

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Christine Dolores and Marcella Tarin conducted an unannounced visit to deliver the finding of the complaint investigation. LPAs met with Adminstrator, Josephine Arcilla.

On 05/08/2024, the Department received the complaint alleging staff (S1) sexually abused resident (R1) while in care. On 05/09/2024, the initial complaint investigation was conducted.

Based on interview with R1, R1 stated S1 came into his/her room and when asked about details of what happened, R1 replied “we had intercourse, I think”. R1 explained that R1 thinks R1 and S1 had intercourse, denied the observation, denied any feeling, and think it’s because of R1’s medical condition. R1 believed the only reason he/she thought that he/she had some type of interaction with S1 is that R1 “thinks” S1 “felt something”. However, R1 does not remember how he/she knew that S1 “felt something”. PAGE 1 OF 2.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Christine Dolores	TELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

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 26-AS-20240508140805

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: VALLEY HAVEN III	FACILITY NUMBER: 445202401
	VISIT DATE: 09/10/2024

NARRATIVE

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The week of 04/29/2024 to 05/05/2024, S1 worked on Monday, 04/29/2024 on the morning shift and Friday, 05/03/2024, on the afternoon shift. Administrative staff ruled out the incident occurring between S1 and R1 on Monday, 04/29/2024 because R1 was not in his/her room during the morning shift.

For the afternoon shift on Friday, 05/03/2024, S1 was working with 2 caregivers (S2) and (S3). S2 and S3 did not mention anything unusual while working with S1. Residents interviewed also did not mention any issues with S1.

Based on interview with S1, S1 denied the allegations. It was stated that on 05/03/2024, the only incident he/she remembered with R1 was attempting to clean R1 after R1 defecated. S1 stated that he/she had to lift R1 in other to clean R1, and then S2 came to finishing wiping and changing R1. S2 corroborated S1’s statement and confirmed to help S1 clean up R1. According to S2, there was nothing inappropriate that occurred. S2 indicated that R1 did not have any other interactions with R1 the remainder of the shift.

The Sheriff’s spoke with R1’s relative who stated R1 indicated that no sexual intercourse had occurred. R1’s relative explained that the staff might have climbed on top of R1 and performed outercourse, but there was no penetration.

The Department has investigation the above allegation. Based on interviews and record review the above allegation is unsubstantiated. An unsubstantiated finding indicates that although the allegation may have happened and/or is valid there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies were cited per California Code of Regulations, Title 22.

This report was reviewed with Administrator, Josephine Arcilla and a copy of the report was provided.

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SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Christine Dolores	TELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

LIC9099 (FAS) - (06/04)

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