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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565800174
Report Date: 04/27/2023
Date Signed: 04/27/2023 11:55:37 AM

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
04/04/2023 and conducted by Evaluator Kasandra Lopez
COMPLAINT CONTROL NUMBER: 29-AS-20230404105307
FACILITY NAME:RMC RESIDENTIAL CARE HOME IIFACILITY NUMBER:
565800174
ADMINISTRATOR:RICHARD CARINOFACILITY TYPE:
735
ADDRESS:1925 BEAUFORT AVE.TELEPHONE:
(805) 483-4628
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:6CENSUS: 6DATE:
04/27/2023
UNANNOUNCEDTIME BEGAN:
10:44 AM
MET WITH:Ryan Carino and Martin CarinoTIME COMPLETED:
12:05 PM
ALLEGATION(S):
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Staff hit client
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 allegation. Tri-Counties Regional Center Quality Assurance Specialist (QAS) Liz Aced-Arnett was also present. Administrators Ryan Carino and Martin Carino arrived at 11:10 AM.

The allegation of "Staff hit client" alleges Staff #1 (S1) hit Client #1 (C1) during the night on 03/26/2023 which was witnessed by Client #2 (C2). During the initial inspection on 04/05/2023, the LPA conducted an interview with C2 and reviewed facility records. The LPA attempted to interview C1 but they are non-verbal.
Today 04/27/2023 at 10:04 AM, the LPA and QAS conducted a telephone interview with S1. During today's inspection, additional facility records were reviewed.

Report continued on LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
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 29-AS-20230404105307
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: RMC RESIDENTIAL CARE HOME II
FACILITY NUMBER: 565800174
VISIT DATE: 04/27/2023
NARRATIVE
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During the interview with C2, C2 denied observing S1 hit C1 and stated they going through some personal stress at the time and only observed S1 help C1 up after they fell at night. During the interview with S1, S1 denied ever hitting C1 and stated they only helped C1 up after they fell multiple times during the night. Record review revealed S1 was the only staff working during the over night shift.

Based on the information obtained, there is insufficient evidence to support the allegation of 'Staff hit Client' occurred. Therefore, the allegation is deemed unsubstantiated at this time. Exit interview conducted and a copy of the report and appeal rights were provided.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2