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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800174
Report Date: 09/22/2022
Date Signed: 09/22/2022 04:50:14 PM

Document Has Been Signed on 09/22/2022 04:50 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 IIFACILITY NUMBER:
565800174
ADMINISTRATOR:RICHARD CARINOFACILITY TYPE:
735
ADDRESS:1925 BEAUFORT AVE.TELEPHONE:
(805) 483-4628
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY: 6CENSUS: 6DATE:
09/22/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Richard and Joy CarinoTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced Case Management - Incident inspection at the facility today to follow up on a previous investigation and met with Administrators Richard and Joyce Carino.

The reason for today's inspection is to follow up on the self reported death report received on 11/15/2021 pertaining to Resident #1 (R1) who passed away on 11/14/2021. During previous inspections on 11/16/2021 and 11/22/2021, the LPA conducted interviews with staff and reviewed facility records. The LPA has since received and reviewed the subpoenaed hospital records and the Autopsy Report. The manner of death listed was natural.

No deficiencies cited. No further investigation is needed at this time. Exit interview and report reviewed with Joy Carino. A copy of the report was emailed.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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