565801134-11-3-2021-29-AS-KHEN-C8VUK2-20211118143825

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801134
Report Date: 11/03/2021
Date Signed: 11/03/2021 11:39:20 AM

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
10/25/2021 and conducted by Evaluator Kelly Dulek

COMPLAINT CONTROL NUMBER: 29-AS-20211025151527

FACILITY NAME:	OCEANVIEW WORKSHOP & RECREATION CENTER		FACILITY NUMBER:	565801134
ADMINISTRATOR:	DEBBIE HERNANDEZ		FACILITY TYPE:	775
ADDRESS:	575 EAST SURFSIDE DRIVE		TELEPHONE:	(805) 986-4818
CITY:	PORT HUENEME	STATE: CA	ZIP CODE:	93041
CAPACITY:	150	CENSUS: 50	DATE:	11/03/2021
		UNANNOUNCED	TIME BEGAN:	10:24 AM
MET WITH:	Debbie Hernandez & Sarah Armstrong		TIME COMPLETED:	11:40 AM

ALLEGATION(S):

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Client was hit by another client

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek conducted an initial complaint investigation for the allegation listed above. LPA arrived at the facility at 10:24 AM and initially met with Sarah Armstrong and Anita (Cindy) Armstrong. Administrator Debbie Hernandez joined at 10:33 AM. Entrance interview conducted.

During today's visit, LPA conducted a facility tour along with Sarah Armstrong and Anita (Cindy) Armstrong at 10:26 AM, interviewed the three (3) Administrative staff at 10:34 AM, conducted client and staff interviews from 10:42 AM to 11:15 AM, and reviewed pertinent client file information. The following was then determined:

File review revealed that Client #1 (C1) has a history of "false statements that someone is hurting (C1) or something has occurred that did not occur." Interview revealed that C1 had experienced trauma in the past and continues to speak of the trauma as if it were happening currently. Interviews revealed that staff and

REPORT CONTINUED ON LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021

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 29-AS-20211025151527

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: OCEANVIEW WORKSHOP & RECREATION CENTER	FACILITY NUMBER: 565801134
	VISIT DATE: 11/03/2021

NARRATIVE

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other clients have not seen anyone hit C1. C1 has a staff person with them at all times during program whenC1 is up from their table. LPA observed all clients seated at designated tables during the program and all clients maintaining a 6 foot social distance from other clients. C1's designated table is in the next row and 2 tables away from Client #2 (C2)'s table. There were no marks or bruises observed on C1 at the time of the visit. Based on observation, interview, and record review, although the allegation may have happened or is valid, at this time there is insufficient evidence to prove the allegation, therefore the allegation that "client was hit by another client" is deemed UNSUBSTANTIATED at this time.

No deficiencies were cited during today's visit. Exit interview conducted. A copy of the report was provided via email.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021

LIC9099 (FAS) - (06/04)

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