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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609631
Report Date: 04/06/2025
Date Signed: 04/06/2025 11:29:36 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
09/26/2024 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20240926144530
FACILITY NAME:GOLDEN HILLS RETIREMENT CTR INCFACILITY NUMBER:
197609631
ADMINISTRATOR:GUEVARA, ITZELFACILITY TYPE:
740
ADDRESS:10159 HILLHAVEN AVETELEPHONE:
(818) 352-1559
CITY:TUJUNGASTATE: CAZIP CODE:
91042
CAPACITY:60CENSUS: 40DATE:
04/06/2025
UNANNOUNCEDTIME BEGAN:
08:54 AM
MET WITH:Adriana Cisneros - Assistant AdministratorTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff did not prevent resident from being sexually abused
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit at this facility to deliver the findings for the above allegation. LPA met with Assistant Administrator Adriana Cisneros and explained the reason for the visit.

On 09/26/24, a complaint was received by the Woodland Hills Adult and Senior Care Regional Office. The complaint was referred to and accepted as an assignment by Community Care Licensing Division’s Investigations Branch (IB) and assigned to IB investigator Olivia Spindola to interview Resident #1 (R1).

On 09/27/2024 at 9:16 AM, LPA initiated the complaint visit. LPA interviewed the assistant administrator, staff and residents and obtained copies of the facility records relevant to the investigation.

(continued to LIC 9099)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2025
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 31-AS-20240926144530
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GOLDEN HILLS RETIREMENT CTR INC
FACILITY NUMBER: 197609631
VISIT DATE: 04/06/2025
NARRATIVE
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(continued from LIC 9099)

During the course of the investigation, LPA Tan interviewed the assistant administrator, staff, and resident on 09/27/24 between 10:30 AM PM to 1:15 PM. Investigator Spindola interviewed R1 on 10/23/24 at approximately 12:30 PM.

Regarding the allegation that Staff did not prevent resident from being sexually abused, it was alleged that R1 was sexually abused by Resident #2 (R2). Investigator Spindola’s interview with R1 revealed that no other resident bothered R1. Further, R1 denied being raped or sexually abused by R2 at any time.

LPA’s record review on 03/29/25 at 9:44 AM revealed that R1 has a history of false accusation against staff and resident prior to this complaint, please see report dated 09/15/22 (complaint control no.: 31-AS-20220321155906) and 03/28/24 (complaint control no.: 31-AS-20240320145828) LPA’s interview with Assistant administrator also confirmed that R1 had accused R2 before and other staff of abusing R1 physically and sexually but it never really happened as R1’s room is located just in front of the front office which is manned by a staff 24/7.

Based on the information gathered during the course of the investigation, the allegation is deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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