565801321-8-15-2023-29-AS-TCAA-CUQSB5-20230815134323

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565801321
Report Date: 08/15/2023
Date Signed: 08/15/2023 01:44:33 PM

Document Has Been Signed on 08/15/2023 01:44 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	CORTES ADULT FAMILY HOME		FACILITY NUMBER:	565801321
ADMINISTRATOR:	FLORO P CORTES JR		FACILITY TYPE:	735
ADDRESS:	316 WALNUT DRIVE		TELEPHONE:	(805) 485-3445
CITY:	OXNARD	STATE: CA	ZIP CODE:	93036
CAPACITY: 6		CENSUS: 5	DATE:	08/15/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	10:41 AM
MET WITH:	Floro Cortes		TIME COMPLETED:	12:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Allegation regarding self-reported incident: Neglect/Lack of Supervision – Facility employees failed to provide an appropriate level of supervision which resulted in Client #1 (C1) inappropriately touching Client #2 (C2) in the groin area. Licensing Program Analyst (LPA) Teresa Camara conducted a Case Management - Deficiencies visit to issue final findings and citations related to the Case Management visit conducted on 04/26/2023. LPA Camara met with licensee/administrator Floro Cortes and explained the reason for the visit. On 04/26/2023, from 8:20 a.m. to 9:55 a.m., LPA Teresa Camara conducted a case management - incident visit. LPA Camara was joined by Tri-Counties Regional Center (TCRC) Quality Assurance Specialist (QAS) Katy Robison. The LPA and QAS met with Staff 1 (S1) and conducted a brief facility tour at 8:25 a.m. All clients except Client #2 (C2) were in day program. The LPA reviewed and obtained pertinent records starting at 8:35 a.m. The Administrator Floro Cortes arrived at 8:55 a.m. The LPA explained the reason for the visit was regarding an incident which took place on 4/14/2023 between Client #1 (C1) and (C2). The Administrator was informed the investigation of the incident would be conducted by the Community Care Licensing (CCL) Investigations Branch (IB). On 05/11/2023, from around 6:30 p.m. to 8:05 p.m., IB Investigator Douglas Real conducted interviews with clients and staff; and from 06/07/2023 to 07/24/2023, contacted the Ventura County Sheriff’s Department. In addition, Investigator Real also reviewed facility file documents related to C1 and C2.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: CORTES ADULT FAMILY HOME	FACILITY NUMBER: 565801321
	VISIT DATE: 08/15/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(continued from 809)

On 04/19/2023, the facility self-reported that C2 disclosed they were inappropriately touched by C1. The incident report documented that on 04/14/2023 at 1:30pm, C1 arrived at the facility from the day program. When C1 entered the facility, C1 entered the room of C2 and inappropriately touched C2 in the groin area. There were no witnesses to the incident. C2 reported the incident to S1, who then reported to the Administrator. C1 and C2 were told by staff to stay out of each other’s rooms and the staff was instructed to always monitor and be aware of C1’s location within the home and restrict entry into C2’s room as well as any of the other client rooms.

Further investigation revealed that incidents of inappropriate touching between C1 and C2 have occurred in the past. On 02/18/2023 and 02/25/2023, C2 reported to S1 that C1 had inappropriately touched C2’s private area while C2 was showering. The Administrator reported these incidents to LPA Camara during the 04/26/2023 initial case management visit. LPA Camara advised the Administrator to submit reports for the incidents to CCL and TCRC. The Administrator submitted reports for both incidents on 04/26/2023 as directed. (Note: Licensee was cited for failure to report incidents on complaint 29-AS-20230728132731 on 8/2/2023.)

On 07/24/2023, Investigator Real spoke with Ventura County Sheriff’s Department Detective Oren Ryerson. Detective Ryerson advised a deputy responded to the facility (incident #23-49352) and spoke with the clients involved in the incident. The incident was closed as it was determined no crime occurred and no report was taken.

Interviews were conducted with the clients in the facility as well as with S1. C2 did not disclose any sexual touching by C1, however, C1 admitted to engaging in sexual touching with C2 during the interview process. S1 did not observe the touching however S1 had found C1 in C2’s bedroom and C2 reported to S1 that C1 inappropriately touched C2. S1 stated they believe they are unable to properly supervise the clients because they are the only staff on duty during the shift.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: CORTES ADULT FAMILY HOME	FACILITY NUMBER: 565801321
	VISIT DATE: 08/15/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(continued from 809-C page 2)

The information obtained during the Department’s investigation sufficiently supports the allegation, therefore, the allegation “Neglect/Lack of Supervision – Facility employees failed to provide an appropriate level of supervision which resulted in Client #1 (C1) inappropriately touching Client #2 (C2) in the groin area” is deemed Substantiated at this time.

Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited (refer to LIC 809-D). Exit interview conducted, appeal rights provided, a copy of this report issued.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 08/15/2023 01:44 PM - It Cannot Be Edited

Created By: Teresa Camara On 08/15/2023 at 12:14 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: CORTES ADULT FAMILY HOME	FACILITY NUMBER: 565801321
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/15/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/22/2023 Section Cited CCR 80078(a)	1 2 3 4 5 6 7	80078(a) Responsibility for Providing Care and Supervision. (a) The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee will submit a plan how they will ensure staff supervision for all clients including a current LIC500 Personnel Report showing 24/7 adequate staff coverage. Submit to CCL by 8/22/2023.
	8 9 10 11 12 13 14	Based on interviews, the licensee did not comply with the above section by failing to protect C2 from inappropriate touching by C1, which posed an immediate health and safety risk to clients in care.	8 9 10 11 12 13 14
Type A 08/22/2023 Section Cited CCR80072(a)(1)(2)	1 2 3 4 5 6 7	80072(a)(1)(2) Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons. (2) To be accorded safe, healthful	1 2 3 4 5 6 7	Licensee will have staff and clients complete Personal Rights training. Submit proof of completion to CCL by 08/22/2023.
	8 9 10 11 12 13 14	and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the above section by failing to protect C2 from inappropriate touching by C1, which posed an immediate health and safety risk to clients in care.	8 9 10 11 12 13 14

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:

Jeralyn Ann Pfannenstiel

LICENSING EVALUATOR NAME:

Teresa Camara

LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC809 (FAS) - (06/04)

Page: 4 of 4