565800673-1-29-2025-29-AS-KLOZ-DDG4HB-20250131180652

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565800673
Report Date: 01/29/2025
Date Signed: 01/29/2025 03:06:11 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. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/05/2024 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20241205155850

FACILITY NAME:	CACCAM'S SORREL RESIDENCE		FACILITY NUMBER:	565800673
ADMINISTRATOR:	VENIS CACCAM		FACILITY TYPE:	740
ADDRESS:	1325 SORREL STREET		TELEPHONE:	(805) 522-9510
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93065
CAPACITY:	5	CENSUS: 5	DATE:	01/29/2025
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Joy Duya		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff Physically Abused Resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced subsequent complaint visit to investigate the allegations listed above. Upon arrival LPA met with staff and explained the reason for the visit. Administrator Venis Caccam was contacted and stated they could not be onsite for the visit , but stated staff Joy Duya can sign in their place.

On 12/11/2024, the initial complaint visit was conducted by LPA between approximately 10:10 a.m. - 02:00 p.m. During the visit, LPA conducted physical plant, interviewed staff, residents as well as reviewed and obtained copies of pertinent documentation relevant to the investigation. A collateral visit was conducted at ARC VC - Cochran between approx. 02:05 p.m. - 03:00 p.m. to conduct interviews with three (3) clients. Today LPA conducted physical plant and interviewed staff.

It was reported that "Staff physically abused resident" as it was alleged that Client #1 (C1) was hit and pinched while in care.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025

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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Control Number 29-AS-20241205155850

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: CACCAM'S SORREL RESIDENCE	FACILITY NUMBER: 565800673
	VISIT DATE: 01/29/2025

NARRATIVE

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Continued from 9099

Interviews conducted with four (4) out of five (5) clients in care including C1 revealed that each have never observed staff hit, pinch or harm any client in care. One (1) client was unavailable to interview. LPA's interview with three (3) staff and the Administrator Venis Caccam revealed all four (4) have never observed any staff hit, pinch or harm any client in care. In addition LPA's interview with the family / responsible party of C1, the Administrator and the complainant revealed that C1 has a history of fabricating situations that have not occurred in order to gain attention. The family / responsible party of C1 and the complainant also did not express any potential or immediate concerns for staff at this time. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation, “Staff physically abused resident” is deemed Unsubstantiated at this time.

Exit interview conducted and copy of report issued

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025

LIC9099 (FAS) - (06/04)

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