561703832-2-2-2023-29-AS-DPEA-CP5SPL-20230217130318

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 561703832
Report Date: 02/02/2023
Date Signed: 02/02/2023 04:07:36 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
11/29/2022 and conducted by Evaluator Kasandra Lopez

COMPLAINT CONTROL NUMBER: 29-AS-20221129134803

FACILITY NAME:	JOSEPHINE'S MANOR		FACILITY NUMBER:	561703832
ADMINISTRATOR:	RICHARD T. CARINO II		FACILITY TYPE:	735
ADDRESS:	575 SUNKIST		TELEPHONE:	(805) 483-2006
CITY:	PORT HUENEME	STATE: CA	ZIP CODE:	93041
CAPACITY:	6	CENSUS: 5	DATE:	02/02/2023
		UNANNOUNCED	TIME BEGAN:	12:16 PM
MET WITH:	Joy Carino		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff hit client in care.
Staff threatened client in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced subsequent complaint inspection at the facility today regarding the above allegations. Tri-Counties Regional Center Quality Assurance Specialist (QAS) Liz Aced-Arnett was also present. The LPA and QAS met with Administrator Joy Carino at 12:45 PM and explained the reason for the visit.

On 11/29/2022, Community Care Licensing received complaints of 'Staff hit client in a care' and 'Staff threatened client in care' alleging Staff #1 (S1) hit Client #1 (C1) and staff told C1 to get on their knees and apologize to everyone while a paddle/instrument was over their head.

On 12/06/2022, the investigation was initiated and between 9:40 AM and 11:35 AM, the LPA conducted interviews with Administrator Joy Carino, one staff member and two clients. The LPA also reviewed facility records. During this inspection the LPA was advised C1 no longer resided at the facility. Report continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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-20221129134803

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: JOSEPHINE'S MANOR	FACILITY NUMBER: 561703832
	VISIT DATE: 02/02/2023

NARRATIVE

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During today's inspection, the LPA conducted a physical plant tour beginning at 12:20 PM and observed all drawers, cabinets, closets, and garage areas in the facility. The LPA did not observe any paddles or objects similar to a paddle. At 12:37 PM, a telephone interview was conducted with Staff #1 (S1). During the interview, S1 denied ever hitting C1 or threatening C1 to apologize with a paddle or anything similar. During today's visits, between 12:47 PM and 1:00 PM, the LPA also conducted interviews with three staff members and Administrator Joy Carino. The administrator and the staff members denied observing any staff member hit C1 or threaten C1 to apologize with a paddle or any other object. Clients interviewed during the previous inspection denied having any issues or concerns regarding how staff treated them.

Based on the information, there is insufficient evidence to support the allegations of 'Staff hit client in a care' and 'Staff threatened client in care' occurred. Therefore, the allegations are deemed unsubstantiated at this time. Exit interview and report reviewed with the Administrator.. A copy of the report and appeal rights were provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC9099 (FAS) - (06/04)

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