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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850185
Report Date: 01/24/2025
Date Signed: 01/24/2025 12:30:17 PM

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
01/02/2025 and conducted by Evaluator Erica Mosley
COMPLAINT CONTROL NUMBER: 29-AS-20250102144153
FACILITY NAME:COTTAGES AT THE COLONY OF VALLEY GLEN #4FACILITY NUMBER:
195850185
ADMINISTRATOR:QUINTERO, ELEANORFACILITY TYPE:
740
ADDRESS:6245 MATILIJA AVETELEPHONE:
(818) 855-7035
CITY:VALLEY GLENSTATE: CAZIP CODE:
91401
CAPACITY:6CENSUS: 5DATE:
01/24/2025
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Anna Lee Delrosario - Administrator TIME COMPLETED:
12:35 PM
ALLEGATION(S):
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Staff left residents unsupervised during the night resulting in a resident being taken to the hospital
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced subsequent complaint visit to the above facility. On today's visit at 9:45 a.m., LPA Mosley was greeted by staff who called the Administrator to inform them of the visit. The Administrator, Anna Bernice D. Lee arrived shortly after and the reason for the visit was explained. Entrance interview.

On 01/02/2025 The Department received a complaint regarding the following allegation, Staff left residents unsupervised during the night resulting in a resident being taken to the hospital. During the initial visit on 01/03/2025, LPA conducted a physical plant tour to ensure there were no immediate health and safety concerns, conducted in-person interviews with two (2) residents, four (4) staff including the Administrator. LPA also conducted a file review along with obtained copies of pertinent documents relevant to the investigation.

REPORT CONTINUED ON LIC 9099-C.....
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
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 2
Control Number 29-AS-20250102144153
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: COTTAGES AT THE COLONY OF VALLEY GLEN #4
FACILITY NUMBER: 195850185
VISIT DATE: 01/24/2025
NARRATIVE
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REPORT CONTINUED FROM LIC 9099....

During today’s visit, LPA Mosley conducted a physical plant tour at 9:55 a.m. to ensure there are no immediate health and safety hazards and facility is in compliance with Title 22 Regulations.

On the allegation Staff left residents unsupervised during the night resulting in a resident being taken to the hospital it is the concern of the Reporting Party (RP) that the facility had locked residents inside the facility with no staff supervision. To investigate this complaint, LPA conducted in person interviews with two (2) residents, and four (4) staff including the Administrator along with reviewed relevant documents pertaining to the investigation. Interviews with the residents revealed that they are unaware of any resident recently taken to the hospital at nighttime. Residents stated that they have never been locked in the facility at night without any staff supervision. Furthermore, residents state that there are always staff available as the facility has live in staff who are available 24/7. Residents noted that staff are regularly available with two (2) to three (3) staff scheduled daily and available to them. Staff interviews revealed that they have not had any resident recently taken to the hospital at nighttime. Staff state they have caregivers regularly scheduled and always have staff available to assist residents. Staff state that they have live in staff who are always available to residents who also conduct night checks. Staff deny ever leaving the residents alone at nighttime resulting in a resident being taken to the hospital. Interview with the Administrator revealed that they have not had any recent incident where a resident was taken to the hospital at nighttime. Administrator states that staff have never locked residents in the facility. Furthermore, staff are scheduled regularly covering all shifts as evidence of the staff schedule for the last month. Based on interviews and record review, the Department does not have sufficient evidence to determine that staff left residents unsupervised during the night resulting in a resident being taken to the hospital. Therefore, the above allegation is deemed UNSUBSTANTIATED at this time.

No deficiencies cited. Exit interview conducted. Copy of the report was issued.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2