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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608084
Report Date: 05/17/2022
Date Signed: 05/20/2022 01:23:25 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., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/01/2021 and conducted by Evaluator Rosaura Valenzuela
COMPLAINT CONTROL NUMBER: 31-AS-20210901125210
FACILITY NAME:OUR SWEET HOME INC #3FACILITY NUMBER:
197608084
ADMINISTRATOR:ARUTYUNYAN, TINAFACILITY TYPE:
740
ADDRESS:21054 VINTAGE STTELEPHONE:
(818) 960-5224
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY:6CENSUS: 5DATE:
05/17/2022
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Zeny Reyes, StaffTIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Sexual Abuse
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted a subsequent complaint investigation visit to the facility. LPA met with Staff Zeny Reyes. The purpose of the visit was discussed.

It was reported that a Resident is being sexually abused. During the initial investigation on 9/01/2021 at 10:00am, LPA Patrick Shanahan initiated resident interviews. Interviews revealed that one (01) out of six (06) residents is being sexually abused. Resident #1 (R1) stated that at night strangers come into their room and try to sexually assault them. The alleged abuse usually occurs at night between 8:00pm and 8:30pm. On 5/17/2022 at 10:45am, LPA Valenzuela reviewed R1's physician's report. Records revealed that R1 has a primary diagnosis of Alzheimer's disease with a secondary diagnosis of schizophrenia. LPA was not able to interview R1, since they no longer reside at the facility. Between 10:25am and 10:40am, staff interviews were initiated. Interviews revealed that approximately four months ago, while taking an early morning walk, R1 spoke to a police officer and requested to speak to a judge. The officer deemed R1 to be very confused and took them to the hospital for a psychiatric evaluation.
Continue on 9099-C


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022
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 31-AS-20210901125210
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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: OUR SWEET HOME INC #3
FACILITY NUMBER: 197608084
VISIT DATE: 05/17/2022
NARRATIVE
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Based on interviews and record review, there is not sufficient information to support this allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2