561702356-8-22-2022-29-AS-KHEN-CHMQLF-20220825121552

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 561702356
Report Date: 08/22/2022
Date Signed: 08/22/2022 10:33:13 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/17/2022 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 29-AS-20220517094602

FACILITY NAME:	COTTONWOOD, THE		FACILITY NUMBER:	561702356
ADMINISTRATOR:	FLORO CORTES		FACILITY TYPE:	735
ADDRESS:	1417 LIRIO AVENUE		TELEPHONE:	(805) 647-6046
CITY:	SATICOY	STATE: CA	ZIP CODE:	93004
CAPACITY:	24	CENSUS: 23	DATE:	08/22/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Elvia Lemus		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Client was sexually assaulted by another client while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to deliver the findings for the above allegation. The facility is experiencing active COVID-19 cases; thus, the report was delivered at Cortes Adult Family Home (565801321). The LPA spoke with Licensee Representative Floro Cortes over the phone and explained the reason for the visit. Staff were authorized to sign the report.

On 5/17/2022, the Department received a complaint, which alleged that Client #1 (C1) was sexually assaulted by Client #2 (C2). Community Care Licensing Division’s Investigations Branch (IB) Investigator Philippe Miles was assigned to interview C1. On 05/18/2022, the LPA conducted a physical plant tour, completed a file review from 12:45 p.m. - 1:20 p.m., obtained documents, and interviewed the licensee representative at 1:34 p.m. On 08/09/2022, the LPA interviewed staff at 11:40 a.m., 12:15 p.m., 12:25 p.m., 12:30 p.m., 12:40 p.m.; interviewed residents at 11:45 a.m., 11:55 a.m., 11:57 a.m., 12:00 p.m., 12:05 p.m., 12:20 p.m. and 12:45 p.m. In addition, the LPA interviewed a representative from an adult health care day program at 1:00 p.m. On 05/24/2022, Investigator Miles interviewed C1 at 10:55 a.m.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2022

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 29-AS-20220517094602

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: COTTONWOOD, THE	FACILITY NUMBER: 561702356
	VISIT DATE: 08/22/2022

NARRATIVE

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Regarding the allegation: Client was sexually assaulted by another client while in care.
It was alleged that C2 went into C1’s room and sexually assaulted C1. When the licensee initially heard about the claims, an internal investigation was conducted and the licensee was unable to corroborate the claims. Coupled with C1's history of making false statements and insufficient evidence, the licensee did not seek further medical evaluation for C1, but reported it to the proper authorities. The information obtained from C1’s interview revealed varying statements regarding clients that resided at the facility. C1 made several statements alleging that they had married several facility clients, yet also made claims that C2 had hypnotized C1 into marrying them. Staff and those whom provided therapeutic services to C1 confirmed that due to R1’s mental health diagnosis, it was believed that R1’s claims had the potential to lack validity.

Interviews with clients and staff revealed that they had not observed C2 or any other clients acting inappropriately with C1. C2 denied claims of sexually assaulting C1 and stated that the claims were ‘made up’. C2 denied claims of ever interacting with C1 in a sexual manner and claimed to have never been in C1's room at night, or any other time. Staff whom worked the evening and night shift denied the claim that C2 had ever went into C1’s room at night. In addition, an interview with C1’s roommate supported claims that C2 had not been observed going into their room on any occasion, let alone at night.

Client interviews revealed that clients felt comfortable residing in the facility and believed they were treated well. Clients denied claims of observing, hearing, or suspecting that C2 sexually assaulted C1 and claimed that C2 had appropriate relationships with those in the facility.

Based on the information obtained, there is insufficient evidence to support the claim that C1 was sexually assaulted by C2 while in care. This allegation is deemed Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. Staff were authorized to sign the report. A copy of the report was issued.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2022

LIC9099 (FAS) - (06/04)

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