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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800397
Report Date: 11/22/2024
Date Signed: 11/22/2024 11:48:19 AM

Document Has Been Signed on 11/22/2024 11:48 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 IIIFACILITY NUMBER:
565800397
ADMINISTRATOR/
DIRECTOR:		RICHARD T. CARINO IIFACILITY TYPE:
735
ADDRESS:756 PEARSON ROADTELEPHONE:
(805) 483-2236
CITY:PORT HUENEMESTATE: CAZIP CODE:
93041
CAPACITY: 6CENSUS: 6DATE:
11/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:05 AM
MET WITH:Richard CarinoTIME VISIT/
INSPECTION COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced Case Management – Incident visit to the above facility. The LPA met with Administrator Richard Carino and explained the reason for the visit. When the LPA arrived there were two (2) clients, two (2) staff and the Administrator present. Entrance interview conducted.

The reason for today's inspection is to follow up on a self-reported unusual/incident report received on 11/21/2024. The report pertains to the safety and personal rights of Client #1 (C1). During today's visit starting at 10:10 a.m. the LPA attempted to Interview both clients present, including C1, and interviewed two (2) staff and three (3) co-Administrators. At 11:15 a.m., the LPA reviewed records and received copies of pertinent documents. At 11:40 a.m., the LPA along with the Administrator conducted a physical plant tour.

No immediate health and safety concerns were observed during today's inspection.

Additional report may follow if warranted.

Exit interview conducted. A copy of the report was provided.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024
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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