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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608084
Report Date: 05/27/2022
Date Signed: 05/27/2022 01:54:35 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:
05/27/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Tina Arutyunyan, LicenseeTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Sexual Abuse
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This is an addendum of the previous Licensing Report issued on 5/17/2022.
Licensing Program Analyst (LPA) Rosaura Valenzuela conducted a subsequent complaint investigation visit to the facility. LPA met with Staff who was administrator's designee. The purpose of the visit was discussed.
It was reported that Resident #1 (R1) was being sexually abused.
During the initial visit, on 09/01/2021, R1 was interviewed and appeared to be confused and disoriented. R1’s statement regarding sexual abuse was inconsistent and without a reasonable basis.
At the time of the subsequent visit on 05/17/2022, between 10:25am and 10:40am, LPA Valenzuela spoke with Staff #1 (S1), who indicated that R1 has medical diagnoses that affects their judgement. R1 has a history of making up stories. R1 never disclosed to S1 about sexual abuse.
On 5/17/2022 at 10:45am, LPA Valenzuela reviewed R1's physician's report, which indicated that in addition to a Dementia diagnosis, R1 has other mental health problems. A review of the physician report and other facility records verified the information received from staff.
Based on interviews and record review there is no sufficient information to verify this allegation.
Therefore, the allegation is UNSUBSTANTIATED at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022
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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