561702356-12-28-2023-29-AS-KLOZ-CZXPNG-20240129102751

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 561702356
Report Date: 12/27/2023
Date Signed: 12/28/2023 08:12:36 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
12/26/2023 and conducted by Evaluator Teresa Camara

COMPLAINT CONTROL NUMBER: 29-AS-20231226134000

FACILITY NAME:	COTTONWOOD, THE		FACILITY NUMBER:	561702356
ADMINISTRATOR:	FLORO P CORTES JR		FACILITY TYPE:	735
ADDRESS:	1417 LIRIO AVENUE		TELEPHONE:	(805) 647-6046
CITY:	SATICOY	STATE: CA	ZIP CODE:	93004
CAPACITY:	24	CENSUS: 24	DATE:	12/27/2023
		UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Marcial San Juan		TIME COMPLETED:	04:35 PM

ALLEGATION(S):

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Lack of supervision resulted in sexual abuse of client.
Facility staff failed to assist client with self-administration of medication.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Teresa Camara conducted an initial complaint investigation visit to the facility. Upon arrival there were two caregivers present. LPA spoke with administrator Floro Cortes Jr. over the phone. He was out of the area and could not meet with LPA. LPA explained the allegations and reason for the visit. The administrator authorized the facility manager Marcial San Juan to sign the report. The facility manager arrived at the facility at 2:30 p.m.

At 2:35 p.m. LPA reviewed medications for Client 1 (C1). At 2:40 p.m. LPA reviewed and obtained pertinent documents for C1 and Client 2 (C2). At 3:00 LPA attempted to interview C2 but they were not willing to speak with LPA. At 3:03 p.m. LPA interviewed C1. At 3:10 p.m. LPA interviewed the facility manager.

(continued on 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023

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 29-AS-20231226134000

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: COTTONWOOD, THE	FACILITY NUMBER: 561702356
	VISIT DATE: 12/27/2023

NARRATIVE

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(continued from 9099)

C1 denied being touched in a sexual manner by C2. C1 stated they take medication to help them sleep and would not know if anyone touched them. C1 recalled phoning the crisis team on 12/24/2023 and stated the police came to the facility as well. Officers asked C1 if they hear voices or see things that are not there and C1 confirmed that does happen. C1 rescinded the allegation.

C1 stated they always take their medications and they have no issues with their medications. C1 stated it was C2 who does not take their medications. C2 will put the medications in their mouth and then go somewhere and spit them out, usually in the toilet.

The facility manager confirmed that C1 has a history of making false allegations of sexual abuse. Each time the police do not pursue an investigation because after speaking with C1, C1 rescinds the allegation.

The facility manager stated C2 has issues with taking their medications. Staff will hand the medications to C2, C2 puts the medications in their mouth and sometimes will take it but other times will spit out the medications. Just last night the facility manager gave C2 their medications, C2 then went into the bathroom saying they had to throw up and then spit out the medications in the toilet. Staff have found C2's medications in the toilet, outside by the trees on the side of the facility, and under C2's bed. They have notified C2's caseworker and even sent photos of the medications to them. C2's caseworker is working on finding a higher level care facility for C2. The facility manager stated when they are aware C2 spit out their meds they will make a note in their log book and notify the administrator.

Based on information obtained through interviews, the allegation that lack of supervision lead to sexual abuse of C1 is deemed Unsubstantiated at this time.

Based on information obtained through interviews and record review, the allegation facility staff failed to assist client with self-administration of medication is deemed Unsubstantiated at this time.

Exit interview conducted and copy of the report issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023

LIC9099 (FAS) - (06/04)

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