565801256-9-30-2021-29-AS-DPEA-CH8RL3-20220812130627

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801256
Report Date: 09/30/2021
Date Signed: 09/30/2021 06:39:09 PM

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
09/13/2021 and conducted by Evaluator Kasandra Lopez

COMPLAINT CONTROL NUMBER: 29-AS-20210913092920

FACILITY NAME:	EJ'S FAMILY HOME		FACILITY NUMBER:	565801256
ADMINISTRATOR:	WILHEMINA ONG		FACILITY TYPE:	735
ADDRESS:	4901 HAMILTON AVENUE		TELEPHONE:	(805) 488-3411
CITY:	OXNARD	STATE: CA	ZIP CODE:	93033
CAPACITY:	6	CENSUS: 6	DATE:	09/30/2021
		UNANNOUNCED	TIME BEGAN:	11:08 AM
MET WITH:	Jomar Ong		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Residents are not afforded privacy in their bedrooms.
Food service inadequate.
Staff will not allow resident to leave.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced subsequent complaint inspection at the facility today beginning 11:08 AM. Tri-Counties Regional Center Quality Assurance Specialist (QAS) Katy Robison was also present. At 11:15 AM Administrator Jomar Ong arrived at the facility and was interviewed.

During today's inspection, the LPA and QAS conducted an interview with Staff #1 (S1) and Staff #2 (S2) beginning at 11:24 AM. Prior to the inspection, the LPA and QAS conducted a collateral inspection today and interviewed Resident #6 (R6).

The allegation of 'Residents are not afforded privacy in their bedrooms' alleges Resident #6 (R6) masturbates in their bedroom in the view of their roommate, Resident #1 (R1). Interviews with R1 and R6 revealed they did not inform staff that they would like more privacy in their bedroom. Report continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021

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-20210913092920

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: EJ'S FAMILY HOME	FACILITY NUMBER: 565801256
	VISIT DATE: 09/30/2021

NARRATIVE

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Interviews with staff revealed they were not aware of this happening and received no complaints from any residents regarding not having enough privacy in their bedroom. During the 09/21/2021 complaint visit, Administrator Maria Miranda was made aware there may be some privacy concerns in R1 and R6's bedroom. The Administrator installed a privacy curtain that day in their bedroom and submitted proof to the LPA and QAS. Interviews with the other residents in the home did not reveal any privacy concerns. Based on the information obtained, the allegation of 'Residents are not afforded privacy in their bedrooms' is found to be unsubstantiated at this time.

The allegation of 'Food service inadequate' alleges residents are only fed food like chicken nuggets, peanut butter and jelly, and rice. During today's inspection and on 09/21/2021, the LPA and QAS observed the food supply and facility menu. Facility had a variety of food, including fruits, vegetables, meats, and grains. Review of the menu revealed for breakfast the residents are served items like oatmeal, eggs, waffles, etc. with a fruit or yogurt and a drink; for lunch they are served a different type of sandwich each day, a fruit or vegetable, and a drink; and for dinner they are served various entree, various side dishes, and a fruit or vegetable, and drink. Residents are also provided snacks between meals. Interviews with five out of the six residents revealed no concerns regarding the food being served. Interviews with residents and staff revealed each week the menu for the following week is reviewed with the residents and the residents will inform the staff if they like the menu or would like something different. Interviews also revealed R1 has their own snacks available if they do not like what is being served. Based on the information obtained, the allegation of 'Food service inadequate' is found to be unsubstantiated at this time.

The allegation of 'Staff will not allow resident to leave' alleges staff do not take residents on outings outside the home. Interviews with staff revealed activities outside the home have been limited due to health and safety concerns related to the COVID-19 pandemic, although residents do go on walks in the neighborhood of the home. Interviews with residents revealed residents would like more activities outside the home but there is insufficient evidence to support facility staff were aware of this. The LPA discussed this allegation with Administrator Jomar Ong. Jomar agreed to offer more safe activities outside the facility for the residents.
Based on the information obtained there is insufficient evidence to support the allegation of staff will not allow resident to leave, therefore the allegation is found to be unsubstantiated at this time.

Exit interview conducted and report reviewed with Jomar Ong. A copy of the report and appeal rights will be emailed.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021

LIC9099 (FAS) - (06/04)

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