565800397-10-8-2021-31-AS-KHEN-C86RU6-20211026131921

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565800397
Report Date: 10/08/2021
Date Signed: 10/08/2021 02:21:34 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
04/23/2020 and conducted by Evaluator Martha Guzman-Chavez

COMPLAINT CONTROL NUMBER: 31-AS-20200423101342

FACILITY NAME:	RMC RESIDENTIAL CARE HOME III		FACILITY NUMBER:	565800397
ADMINISTRATOR:	RICHARD T. CARINO II		FACILITY TYPE:	735
ADDRESS:	756 PEARSON ROAD		TELEPHONE:	(805) 483-2236
CITY:	PORT HUENEME	STATE: CA	ZIP CODE:	93041
CAPACITY:	6	CENSUS: 6	DATE:	10/08/2021
		UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Richard Carino		TIME COMPLETED:	02:21 PM

ALLEGATION(S):

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Staff pushed resident
Resident sustained bruise
Staff restrained resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Martha Guzman Chavez initiated a subsequent complaint visit for the purpose of delivering findings for the above complaint allegations. LPA arrived and initially met with facility staff Gary Fernando who contacted Licensee Richard Carino. Licensee arrived at 1:25 PM. Entrance interview conducted.
During a virtual initial complaint visit on 04/23/2020, LPA Kelly Dulek conducted telephone interviews with the administrators at 3:10PM and 3:13PM, and a joint video call with Quality Assurance Specialist (QAS) Katy Robison of Tri Counties Regional Center to interview Client #1 (C1) at 2:00PM. The LPA also received copies of pertinent documents. Subsequently, LPA along with QA Robison conducted staff and client interviews via FaceTime/telephonically on the following dates: 04/27/20, 04/28/20, 04/29/20, 04/30/20, 05/01/20, 05/07/20, 05/13/20, and 05/21/20. LPA and QAS interviewed additional witnesses, family member and complainant on 05/13/2020. Licensee and Administrator also participated in a virtual meeting with CCLD and Tri-Counties Regional Center regarding the allegations on 06/17/2020.
(...Continued on LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Guzman-Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021

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 31-AS-20200423101342

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 III	FACILITY NUMBER: 565800397
	VISIT DATE: 10/08/2021

NARRATIVE

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(...Continued from LIC 9099...)

Regarding the allegation “staff pushed resident:”

Interview with C1 did initially indicate staff pushed C1, although C1 could not recall when or where this occurred. During the interview, C1 indicated Staff #1 (S1) had grabbed C1 and “pulled” C1 on the wall, but then C1 stated S2 had grabbed C1. C1 then stated, “I can’t think” and wrote “Uncle Sam” when asked who had grabbed C1. Additionally, interview of administrators, facility staff, other clients, and additional parties revealed no one has ever witnessed any staff push C1 and therefore could not corroborate C1’s statement. Based on interviews and observations, although the allegation may have happened or is valid, there is insufficient evidence to prove the allegation did occur. Therefore, the allegation that “staff pushed resident” is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “resident sustained bruise” (due to abuse/lack of supervision):

Throughout the investigation, LPA Dulek reviewed documented staff notes for C1. On 04/17/2020, staff noticed C1 had an oval-shaped reddish-purple bruise on C1’s right bicep. Facility staff did not notice the bruise when C1 left with day program staff. Interviews revealed that staff had observed the bruise on C1’s arm, but no staff observed the injury take place nor could staff identify causation. When C1 was asked about the bruise, C1 stated “I can’t think.” Staff interviews revealed that C1 had attempted to elope from the facility on 04/05/2020 through C1’s window and C1 may have injured their arm during the elopement. Another staff indicated C1 hits their head with the inside of their arm when upset and suggested that may be how C1 sustained the bruising. Interview with day program staff revealed that due to C1’s unsteady gait, C1’s family member has asked day program staff to hold C1’s arm around the bicep area while walking with C1. Based on interviews and documentation, although the allegation may have happened or is valid, there is insufficient evidence to prove the allegation did occur. Therefore, the allegation that “resident sustained bruise” (due to abuse/lack of supervision) is deemed UNSUBSTANTIATED at this time.

(...Continued on LIC 9099C...)

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Guzman-Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20200423101342

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 III	FACILITY NUMBER: 565800397
	VISIT DATE: 10/08/2021

NARRATIVE

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(Continued from LIC 9099C...)

Regarding the allegation “staff (inappropriately) restrained resident:”

Interviews with staff revealed that sometime in March 2020, C1 eloped from the facility and was attempting to enter oncoming traffic when S1 intervened. S1 held C1 in a bear hug to prevent C1 from being injured in the street. Staff stated that when clients elope from the facility, they are trained to follow the client, use de-escalation techniques to talk to the client and return the client back to the facility safely. Only in instances of imminent danger do staff physically intervene. No training records were provided for situations involving physical interventions and interviews revealed staff have not been trained on this topic. Based on interviews, although the allegation may have happened or is valid, there is insufficient evidence to prove the allegation did occur, therefore, the allegation that “staff (inappropriately) restrained resident” is deemed UNSUBSTANTIATED at this time.

Additional concerns observed during the course of the investigation will be addressed during a Case Management – Deficiencies visit.

No citations issued. Exit interview conducted. A copy of the report was provided via email.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Guzman-Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021

LIC9099 (FAS) - (06/04)

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