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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800874
Report Date: 05/21/2024
Date Signed: 05/21/2024 12:38:53 PM

Document Has Been Signed on 05/21/2024 12:38 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:RMC RESIDENTIAL CARE HOME #1FACILITY NUMBER:
565800874
ADMINISTRATOR/
DIRECTOR:		RICHARD T. CARINO IIFACILITY TYPE:
735
ADDRESS:4431 BEAUMONT AVENUETELEPHONE:
(805) 488-8504
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY: 4CENSUS: 1DATE:
05/21/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Charles Carino-AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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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 Co-Administrator Charles Carino and explained the reason for the visit. Entrance interview conducted.

The reason for today's inspection is to follow up on a self-reported death report received on 05/17/2024. The report pertains to the death of Client#1 (C1). Per the information received, the circumstances surrounding the death of Client #1 on 05/16/2024 may be questionable and needs to be investigated. It was reported C1 was sent to the hospital on May 15th from their day program and passed away on May 16th at the hospital due to a brain bleed.

During today's visit, the LPA conducted an interview with the administrator throughout the visit, a brief tour of the facility and obtained copies of pertinent documents.

This incident was referred to Community Care Licensing Investigations Branch (IB) for review. Further investigation may be required. An investigator or the LPA may return at a later date if needed.

Exit interview conducted. A copy of the report was issued to the Administrator Charles.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2024
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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