565801532-9-27-2025-29-AS-DPEA-DLYU4X-20250929151551

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801532
Report Date: 09/26/2025
Date Signed: 09/27/2025 05:22:29 PM

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
01/22/2025 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20250122081814

FACILITY NAME:	NORMA J'S HOME FOR THE ELDERLY, THE		FACILITY NUMBER:	565801532
ADMINISTRATOR:	LORETTA LOUISE TIEDE		FACILITY TYPE:	740
ADDRESS:	142 W. COLUMBIA ROAD		TELEPHONE:	(818) 422-7667
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	6	CENSUS: 5	DATE:	09/26/2025
		UNANNOUNCED	TIME BEGAN:	01:06 PM
MET WITH:	Robin Douglas		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff sexually abused resident in care
Staff forced resident to take medications

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Zabel Chochian initiated a subsequent complaint visit to issue finding for the above allegations. Upon arrival, the LPA with staff Robin Douglas at approximately 1p.m. and reason for the visit was explained. Administrator Loretta L. Tiede was contacted and the investigation finding was discussed.
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On 01/21/2025, the Department received a complaint which alleged that resident #1 (R1) was forced to take a medication by Staff #1 (S1) before going to bed on 01/17/2025. It was also reported that R1 was forced to take an unknown medication numerous times while under the care of the facility. In addition, it was alleged that Staff #1 (S1) sexually abused R1 on 01/18/2025. It was reported that R1 felt someone on top of them, pushing down on R1’s pelvic area. R1 reported that they had a diaper on during the incident.

On 01/23/2025, LPA Valeria Conway conducted an unannounced complaint visit to investigate the above allegations. When the LPA arrived, there were three (3) caregivers and six (6) residents present.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2025

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 3

Control Number 29-AS-20250122081814

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: NORMA J'S HOME FOR THE ELDERLY, THE	FACILITY NUMBER: 565801532
	VISIT DATE: 09/26/2025

NARRATIVE

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The LPA was greeted by the caregiver, Robin Douglas. Caregiver contacted the Administrator, Loretta Tiede by phone. At 11:50 a.m. the Administrator arrived at the facility and was informed of the reason for the visit. At 11:55 AM., the LPA, along with Administrator Loretta Tiede, conducted a physical plant tour to ensure there are no immediate health and safety concerns. From 12:30 p.m. to 2:10 pm LPA conducted interviews with the administrator, three (3) caregivers, and a family member. Additionally, LPA attempted to interview two (2) residents and obtained copies of pertinent documents relevant to the investigation.

On 07/16/2025, LPA Chochian conducted a subsequent visit and reviewed additional records including but limited to medication records and procedures. LPA interviewed staff and other potential witnesses on 07/16/2025 and telephonically on 07/18/2025. Staff interviews conducted revealed that R1 had a history of hallucinations and aggression towards staff and would make accusations against staff. Staff expressed being afraid to assist R1 in fear that R1 would make false accusations. Staff reported that R1 was not nice to staff and would make false accusations. During the telephonic interview with R1’s responsible person on 07/16/2025, they also expressed that R1 did have bouts of hallucinogenic episodes, memory issues and was agitated.

Staff interviewed, Including S1 reported that they do not force medications on residents. Staff reported that if residents refused medication, they would give them time and try again later and if residents still refused, they would document and inform the family and physician. Staff and administrator reported that medications are given according to doctors’ orders. R1 did have a standing order for Seroquel 25mg. Facility medication records reviewed noted that R1 refused to take Seroquel on 01/17/2025 and on 01/19/20205 through 01/22/2025.

During the 07/18/2025 telephonic interview, Staff #1 (S1) denied the allegation and reported that they last worked at the facility on or about 12/20/2024. S1 reported that they were not on duty on the alleged incident date and time. Although there is conflicting information on whether S1 worked on the night of the alleged incident. S1 expressed that when they worked at the facility, they treated the residents with respect and provided daily care with no issues and denied being inappropriate with any residents at the facility.

A review of records, including but not limited to preplacement appraisal, medical assessment, and centrally stored medication record. R1 was admitted to the facility in August 2024. R1’s physician report dated 01/25/2025 noted history of short-term memory loss, mild confusion, agitation, and hallucinations.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20250122081814

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: NORMA J'S HOME FOR THE ELDERLY, THE	FACILITY NUMBER: 565801532
	VISIT DATE: 09/26/2025

NARRATIVE

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The previous medical assessment noted mild cognitive impairment, non-ambulatory, incontinent care services, and assistance with daily activities.

During the 01/23/2025 visit, LPA Conway attempted to interview R1, although R1 declined to be interviewed about the alleged incident. Interview conducted with R1’s family member on 01/23/2025, did not reveal any initial reports of abuse by R1 to the family member. R1 has since passed away. During the subsequent visit on 07/16/2025, an attempt was made to interview other residents, however due to residents having cognitive issues the interviews were brief. One resident was able to communicate expressed that they are treated well and felt safe in the facility.

A review of the Ventura County’s Sherriff’s (VCS) report revealed on 01/18/2025, a visit was conducted at the facility and R1, a Staff #2 (S2), and a friend of R1 were interviewed by the Officer. VCS was unable to determine that a crime occurred and closed their case after this visit.

Based on the above information gathered although the allegation may be valid, there is insufficient evidence to support the allegations or that a violation occurred; therefore, the allegations “Staff sexually abused resident in care and Staff forced resident to take medications” is deemed unsubstantiated at this time.

Exit interview conducted. A copy of the report and appealed rights were provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2025

LIC9099 (FAS) - (06/04)

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