565800397-10-23-2023-29-AS-TCAA-CWVM8L-20231023092318

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565800397
Report Date: 10/20/2023
Date Signed: 10/23/2023 09:24:06 AM

Document Has Been Signed on 10/23/2023 09:24 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

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:	10/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Richard Carino II		TIME COMPLETED:	04:50 PM

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Licensing Program Analyst (LPA) Teresa Camara conducted an unannounced Required - 1 Year inspection at the facility today. LPA met with Co-Administrator Josephine Carino, Co-Administrator Charles Carino, and Administrator Richard Carino II. This home is vendored by Tri-Counties Regional Center as a level 4 home.

The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed:

KITCHEN: The kitchen and food storage areas were observed. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food stored in the kitchen and garage. Cleaning supplies and items that could pose a danger were secured in locked cabinets. The facility has a supply of emergency food and water.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and condition. All indoor and outdoor passages were free of obstruction. At the time of the visit, living room and dining room furniture was observed to be in good condition. The fire extinguisher was fully charged and last serviced on 12/19/2022. The carbon monoxide detector and smoke detectors in the home were tested and were operational. Medications are centrally stored and in a locked cabinet in the kitchen. Knives are locked in a cabinet in the hallway. Cleaning supplies were observed to be locked in the garage and inaccessible to residents in care. The backyard has covered seating for resident use.

BEDROOMS: There are three client bedrooms. The LPA observed the client bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.

(Report continued on LIC 809-C)

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: RMC RESIDENTIAL CARE HOME III	FACILITY NUMBER: 565800397
	VISIT DATE: 10/20/2023

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(Report continued from 809)

RESTROOMS: The facility has one restroom for client use. Restroom was observed to be clean and sanitary with hand soap, toilet paper and paper towels. The hot water temperature in the common hallway restroom measured at 114.1*F.

MEDICATIONS: Medications are locked and centrally stored in a locked cabinet in the kitchen area. All medications are labeled and maintained in compliance with label instructions, and state and federal law. All medications reviewed were recorded on the centrally stored medication and destruction record. The LPA inspected the first aid kit, which was complete.

RECORDS: Cash resources for all clients were separate and intact, and not commingled with facility funds or petty cash. The facility has a current surety bond on file. The client files reviewed were found to be complete. Staff files were reviewed and also found to be complete. Disaster drills are conducted every month. The facility has a 30 day supply of personal protective equipment and an emergency disaster plan on file.

No deficiencies were cited during today's inspection. Exit interview and reported reviewed with the Administrator. A copy of the report was provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

LIC809 (FAS) - (06/04)

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