565801257-10-13-2022-29-AS-DPEA-CKKN35-20221026100545

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801257
Report Date: 10/13/2022
Date Signed: 10/13/2022 04:39:28 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
04/08/2022 and conducted by Evaluator Kasandra Lopez

COMPLAINT CONTROL NUMBER: 29-AS-20220408133428

FACILITY NAME:	EJ2 FAMILY HOME		FACILITY NUMBER:	565801257
ADMINISTRATOR:	MARIA MIRANDA		FACILITY TYPE:	735
ADDRESS:	1210 NELSON PLACE		TELEPHONE:	(805) 271-9449
CITY:	OXNARD	STATE: CA	ZIP CODE:	93033
CAPACITY:	6	CENSUS: 6	DATE:	10/13/2022
		UNANNOUNCED	TIME BEGAN:	03:25 PM
MET WITH:	Joemar Ong		TIME COMPLETED:	03:55 PM

ALLEGATION(S):

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Staff hit client
Staff handled client in an inappropriate manner
Facility staff does not treat client with dignity and respect

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced subsequent complaint investigation visit at the facility today. The purpose of this visit is to conclude an investigation initiated on 04/11/2022 by LPA Zabel Chochian. During today’s visit LPA met with Co-Administrator Joemar Ong. Entrance interview conducted.
On 04/08/2022, Community Care Licensing Division (CCLD) received a complaint regarding the above allegations. On 04/11/2022, LPA Zabel Chochian initiated the investigation and conducted interviews with three clients (Client #1 (C1), Client #2 (C2), and Client #3(C3)) between 1:30 PM and 2:00 PM and requested copies of pertinent records. On 04/19/2022, LPA Lopez and Tri-Counties Regional Center, Quality Assurance Specialist (QAS) Katy Robison conducted a subsequent visit and interviewed Client #4 (C4) and Staff #1 (S1) between 12:12 PM and 1:10 PM. Additional subsequent visits were conducted with LPA Lopez and QAS Robison on 05/11/2022 when Client #1 (C1) was interviewed at 8:55 AM and another visit on 05/24/2022 when Staff # 2 (S2) and Staff #3 (S3) were interviewed between 2:27 PM and 2:58 PM. Report continued On LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022

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-20220408133428

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: EJ2 FAMILY HOME	FACILITY NUMBER: 565801257
	VISIT DATE: 10/13/2022

NARRATIVE

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The allegations of Personal rights - ‘Staff hit client’ and ‘Staff handled client in an inappropriate manner’ alleges S2 punched C1 in the face and bent C1’s hand about a year ago.

During the interviews with C1 on 04/11/2022 and 05/11/2022, they denied being physically harmed by any staff at the home. Interviews with three (3) other clients in the home, S1 and S3 revealed no observation of any staff physically hurting any clients in the home or any staff bending C1’s hand. During the interview with S2, they denied ever hitting C1 or placing their hands on C1 at any time. Based on the information obtained there is insufficient evidence to support the allegations of ‘Staff hit client’ and ‘Staff handled client in an inappropriate manner’. Therefore, the allegations are deemed unsubstantiated at this time.

The allegation of ‘Facility does not treat client with dignity and respect’ alleges that S3 bully’s C1 and tells C1 to “keep crying” when they are upset. During the interview with C1, they denied any staff calling them names or making C1 feel bad when they cry and stated staff tell C1 to calm down or take a deep breath when they cry. C1 also stated S1 and S3 make C1 feel better when they cry. During the interview with S3, they denied speaking inappropriately when C1 cries and stated they walk away and give C1 space when crying so they don’t escalate. Interviews with the other clients and staff revealed no reports of staff talking inappropriately with any clients in the home. Based on the information obtained, there is insufficient evidence to support the allegation of ‘Facility does not treat client with dignity and respect’. Therefore, the allegation is deemed unsubstantiated at this time.

Exit interview and report reviewed with Co-Administrator Joemar Ong. A copy of the report and appeal rights were emailed.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022

LIC9099 (FAS) - (06/04)

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