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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800874
Report Date: 09/10/2024
Date Signed: 09/10/2024 03:05:59 PM

Document Has Been Signed on 09/10/2024 03:05 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: 6DATE:
09/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:Charles Carino-AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Emily Peraldi along with Quality Assurance Specialist (QAS) Tri-Counties regional center Katy Robison conducted an unannounced Case Management – Other visit to the above facility at 1:40 p.m. The LPA and QAS met with staff and explained the reason for the visit. At 1:50 p.m., Co-Administrator Charles Carino arrived at the facility. At 2:03 p.m., Oxnard Fire Department Inspector Jesus Topete arrived at the facility.

The reason for today’s visit is to confirm the census of the facility and fire clearance. On 09/06/2024, the fire clearance for the facility was denied and corrections were required. At 2:03 p.m., Fire Inspector reviewed fire clearance corrections. During today’s visit, the Fire Inspector approved the fire clearance clearing them for six (6) ambulatory only residents.

The Administrator, Richard T. Carino requested a change of capacity from four (4) clients to six (6) clients on 08/09/2024. The change of capacity is in process and the facility is currently licensed for four (4) clients. The census is currently six (6) clients and is operating over capacity by two (2) clients.

Per the California Code of Regulations, Title 22, and California Health and Safety Code the following deficiencies were observed and cited during the visit (See 809-D). Civil penalties issued for the amount of $1,500. The Co- Administrator was advised that failure to correct the deficiencies may result in additional civil penalties.

Exit interview conducted. A copy of the report and appeal rights were provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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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Document Has Been Signed on 09/10/2024 03:05 PM - It Cannot Be Edited


Created By: Emily Peraldi On 09/10/2024 at 02:41 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: RMC RESIDENTIAL CARE HOME #1
FACILITY NUMBER: 565800874

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/10/2024
Section Cited
CCR
80020(a)

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80020 Fire Clearance (a) All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal.This requirement is not met as evidenced by:
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On 09/10/2024, the Fire Inspector Topete approved the facility for a fire clearance of six (6) Ambulatory only residents. Plan of correction met.
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Based on record review, the licensee did not comply with the section cited above as fire clearance was denied on 09/06/2024 which poses an immediate health and safety risk to persons in care.
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Civil penalty in the amount of $1000 assessed.
Type A
09/11/2024
Section Cited
CCR80010(a)

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80010 Limitations on Capacity and Ambulatory Status (a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including the capacity limitation. This requirement is not met as evidenced by:
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A change in capacity is currently pending.
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Based on observations and record review, the licensee did not comply with the section cited above as the facility is operating over capacity by two (2) clients as they are licensed for four (4) and currently have six (6) clients which poses an immediate health and safety risk to persons in care.
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Civil penalty in the amount of $500 assessed.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Kristin Heffernan
LICENSING EVALUATOR NAME:Emily Peraldi
LICENSING EVALUATOR SIGNATURE:
DATE: 09/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2024


LIC809 (FAS) - (06/04)
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