197609011-9-29-2025-31-AS-NGID-DPTP4H-20251229095906

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609011
Report Date: 09/29/2025
Date Signed: 09/29/2025 04:01:39 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
02/21/2025 and conducted by Evaluator Evelin Rios

COMPLAINT CONTROL NUMBER: 31-AS-20250221124252

FACILITY NAME:	STRAWBERRY COTTAGE		FACILITY NUMBER:	197609011
ADMINISTRATOR:	GORY, MONICA		FACILITY TYPE:	740
ADDRESS:	43732 SENTRY LANE		TELEPHONE:	(661) 266-7995
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY:	6	CENSUS: 3	DATE:	09/29/2025
		UNANNOUNCED	TIME BEGAN:	12:52 PM
MET WITH:	Celsa Castaneda - Staff		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff are not safeguarding resident's personal belongings
Staff are not meeting resident's toileting needs

INVESTIGATION FINDINGS:

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On 09/29/2025 Licensing Program Analysts (LPA) Evelin Rios conducted an unannounced subsequent complaint visit for the above mentioned allegations. LPA arrived to the facility and was granted access by Celsa Castaneda, Staff #2 (S2). S2 contacted Monica Gory, the administrator by telephone and LPA explained the purpose of the visit. An entrance interview was conducted with the administrator. Administrator would not arrive in time to meet with LPA. S2 was designated to sign today's report.

On 02/25/2025 LPA Rios conducted an initial visit to investigate the allegations. During initial visit LPA conducted an interview with the administrator and S2. From approximately 10:54 a.m. to 1:26 p.m., LPA reviewed resident records and obtained Resident #1's (R1's) documents such as but not limited Assisted Living Waiver documentation, Resident Report and Observations, Unusual Incident / Injury Reports, Physician's Report, Resident Appraisal and Bowl and Bladder logs. At 2:00 p.m., while conducting the physical plant tour LPA attempted to interview Resident #3 (R3), but they refused to be interviewed.
(Continue to LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2025

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 4

Control Number 31-AS-20250221124252

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: STRAWBERRY COTTAGE	FACILITY NUMBER: 197609011
	VISIT DATE: 09/29/2025

NARRATIVE

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LPA attempted to interview Resident #4 (R4) but they were sleeping. LPA attempted to interview Resident #5 (R5) but they did not respond to LPA's questions. From approximately 2:25 p.m. to 2:40 p.m., LPA conducted interviews with two (2) residents, Resident #1 (R1) and Resident #2 (R2). LPA documented observations of R1's bedroom.

On 09/09/2025, while conducting the unannounced annual required visit, at approximately 10:25 AM, LPA interviewed R4.

On todays unannounced subsequent visit to continue the investigation on the allegations, LPA Rios while conducting a tour at approximately 1:10 p.m., interviewed Resident #3 (R3). From 2:17 to 2:45 p.m., LPA interviewed Staff #1(S1) and Staff #3 (S3) by telephone.

Allegation: Staff are not safeguarding resident's personal belongings. It was alleged that 24 bananas, purchased by R1's family member, were gone in three days. To investigate the allegation, LPA Rios interviewed four (4) out of five (5) residents that resided in the home, the administrator, and three (3) staff members. Interview with R1 confirmed they had received several bunches of bananas but they were gone in a short amount of time. R1 was not able to recall how long after receiving the bananas they were gone or how often they ate bananas. The administrator and three (03) staff members revealed that R1 ate bananas with every meal sometimes two at a time with meals. Staff and three (3) resident out of the four (04) residents interviewed corroborate they did not eat R1's bananas and did not witness anyone eating R1's bananas. According to S2 they write resident's names on food items residents personally bring for themselves to consume. During physical plant tour on 02/25/2025 and on subsequent visits LPA observed resident's names on food items.

Based on interviews, and observation there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

(Continue to LIC9099-C) Page 2 of 3

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 31-AS-20250221124252

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: STRAWBERRY COTTAGE	FACILITY NUMBER: 197609011
	VISIT DATE: 09/29/2025

NARRATIVE

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(Continued from LIC9099-C) Allegation: Staff are not meeting resident's toileting needs. It is alleged, R1 uses a portable urinal then dumps it into a bucket next to their bed because staff will not respond to call button for assistance. During the investigation, LPA Rios interviewed four (4) out of five (5) residents that resided in the home, the administrator, and three (3) staff members. LPA's interview with R1 revealed they wear incontinent undergarments because they do not like to sit on a toilet. According to R1 the sitting position is not ideal for emptying their bladder or bowl movements. R1 states they have no issues regarding their portable urinal and bucket. Stating to LPA that staff empty the bucket several times a day with no issues. According to R1 they prefer to "dump the urine" in the "commode bucket" and have staff empty the bucket. Interview with three (3) staff and the administrator corroborate R1's preference. According to the administrator and staff they have encouraged R1 to use the toilet or commode but R1 refuses. LPA's interview with four (4) out of five (5) residents corroborate no issues or concerns regarding toileting needs.

Based on interviews, and observation there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Exit interview conducted. Copy of report provided. Appeal rights provided.

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SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2025

LIC9099 (FAS) - (06/04)

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