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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609011
Report Date: 06/14/2023
Date Signed: 06/14/2023 03:13:23 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
04/27/2023 and conducted by Evaluator Evelin Rios
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20230427111039
FACILITY NAME:STRAWBERRY COTTAGEFACILITY NUMBER:
197609011
ADMINISTRATOR:TAYLOR, DAVID JAMESFACILITY TYPE:
740
ADDRESS:43732 SENTRY LANETELEPHONE:
(661) 266-7995
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:6CENSUS: 6DATE:
06/14/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:David James TaylorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff do not ensure safety measures for resident(s) in care.
INVESTIGATION FINDINGS:
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On 06/14/2023 Licensing Program Analysts (LPAs) Evelin Rios and Melissa Ruiz conducted an announced subsequent complaint visit for the above allegation. LPAs arrived at the facility at 10:00 a.m. and were greeted by staff#1 (S1) who granted access. S1 called the Administrator David James Taylor. Administrator met LPAs shortly after and informed David about the purpose of the visit.

Staff do not ensure safety measures for resident(s) in care.

It is alleged a staff #2 (S2) dog chased resident#1 (R1) to their room. To investigate this allegation LPA Rios conducted initial interviews with residents and staff on 05/02/2023 from 2:00 p.m. to 2:50 p.m. and from 5:45 p.m. to 6:32 p.m. LPA reviewed resident records and obtained documents relevant to this investigation. On 05/03/2023 Licensing Program Analyst (LPA) Rios conducted a follow-up interview with resident#1 at 10:21 a.m.
(LIC9099-C continued on to next page)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
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 31-AS-20230427111039
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: STRAWBERRY COTTAGE
FACILITY NUMBER: 197609011
VISIT DATE: 06/14/2023
NARRATIVE
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At 10:36 a.m. LPA reviewed and obtained further documents relevant to this investigation. Interviews and documentation revealed S2 has a service or assistance animal they bring to work. Interviews with staff and residents are not consistent on the behavior of the animal. LPA Rios reviewed PIN 17-05-ASC SERVICE AND ASSISTANCE ANIMALS. Based on interviews and record reviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

An exit interview was conducted, and a copy of this report was provided.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
LIC9099 (FAS) - (06/04)
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