565800034-9-25-2024-29-AS-DPEA-D9HUKD-20240927153857

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565800034
Report Date: 09/25/2024
Date Signed: 09/25/2024 03:18:03 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
11/21/2023 and conducted by Evaluator Teresa Camara

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20231121142729

FACILITY NAME:	BALLARD FAMILY HOME		FACILITY NUMBER:	565800034
ADMINISTRATOR:	BONITA BALLARD 98		FACILITY TYPE:	735
ADDRESS:	1611 BROOKSIDE AVENUE		TELEPHONE:	(805) 985-6493
CITY:	OXNARD	STATE: CA	ZIP CODE:	93035
CAPACITY:	6	CENSUS: 6	DATE:	09/25/2024
		UNANNOUNCED	TIME BEGAN:	12:55 PM
MET WITH:	Morris Pippins		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff handled resident in a rough manner
Staff did not provide a comfortable environment for resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint investigation visit. LPA met with administrator Morris Pippins and explained the reason for the visit.

During LPA's visit on 11/29/2023, LPA reviewed and obtained pertinent documents, interviewed staff and the administrator. LPA conducted an interview with staff 4 (S4) away from this facility on 2/23/2024. During today's visit, LPA interviewed the administrator again at 1:00 p.m. Based on interviews with staff and the administrator, nobody has ever witnessed S4 handle any client in a rough manner or treat clients rudely. The behaviors (yelling and biting their own hand) exhibited by client 1 (C1) on the day of the incident with the bus driver was not unusual behavior for C1 and C1 is non-violent. It was noted the bus driver did not have an assistant on that day and C1 was new to the driver. There may have been some misunderstanding regarding C1's behaviors and how staff responded to those behaviors by proceeding to guide C1 into the bus while C1 was still having some behaviors. Based on interviews, the above noted allegations are deemed unsubstantiated at this time. Exit interview conducted and report issued.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

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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