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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609791
Report Date: 09/03/2021
Date Signed: 09/03/2021 12:04:24 PM

Unfounded


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
08/27/2021 and conducted by Evaluator Wendell Smith
COMPLAINT CONTROL NUMBER: 31-AS-20210827143626
FACILITY NAME:ATWATER VILLAGE SOUTHFACILITY NUMBER:
197609791
ADMINISTRATOR:ESPIRITU, JOCELYNFACILITY TYPE:
740
ADDRESS:3454 PERLITA AVETELEPHONE:
(323) 665-6893
CITY:LOS ANGELESSTATE: CAZIP CODE:
90039
CAPACITY:6CENSUS: 6DATE:
09/03/2021
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jocelyn Espiritu TIME COMPLETED:
10:45 AM
ALLEGATION(S):
1
2
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9
Resident is being financially abused while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced initial complaint visit to investigate the allegation above. LPA met with administrator and explained the reason for this visit.
It is alleged that resident #1 (R1) is being financially abused while in care. LPA conducted interviews with administrator, R1's responsible person, and the placement agency Brilliant Corners who placed R1 at this facility. Information from interviews reveal that R1 was being financially abused prior to being placed in this facility and that the financial abuse is ongoing. However the financial abuse has nothing to do with this facility as it did not occur at this facility. R1 has been residing at this facility since 6/28/21 and the abuse has been occuring since 01/2020 according to documents obtained. Based on the information obtained this allegation is deemed Unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.
Exit Interview conducted.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021
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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