565801393-3-8-2022-29-AS-DPEA-CCEU98-20220311142244

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801393
Report Date: 03/08/2022
Date Signed: 03/08/2022 04:59:39 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
10/28/2021 and conducted by Evaluator Kasandra Lopez

COMPLAINT CONTROL NUMBER: 29-AS-20211028101812

FACILITY NAME:	GONZALES FAMILY HOME		FACILITY NUMBER:	565801393
ADMINISTRATOR:	VENIE G. GONZALES		FACILITY TYPE:	735
ADDRESS:	4450 BROWNING DRIVE		TELEPHONE:	(805) 488-2315
CITY:	OXNARD	STATE: CA	ZIP CODE:	93033
CAPACITY:	6	CENSUS: 5	DATE:	03/08/2022
		UNANNOUNCED	TIME BEGAN:	10:07 AM
MET WITH:	Venie Gonzales		TIME COMPLETED:	12:35 PM

ALLEGATION(S):

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Client is being sexually abused
Client is being physically abused
Facility is over capacity

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) KaSandra Lopez conducted a subsequent complaint investigation at this facility today. The purpose of the visit is to deliver findings for the above allegations. The initial visit was conducted by LPA Lopez on 10/29/2021. During today’s visit, LPA Lopez met with Administrator Venie Gonzales. Entrance interview conducted.

It was alleged that Client #1 (C1) was being sexually and physically abused by Client #2 (C2) and Individual # 1 (I1). The case was referred to Community Care Licensing Division (CCLD) Investigation Branch (IB) and assigned to Investigator Brian Slatic.

Report continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022

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

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 29-AS-20211028101812

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: GONZALES FAMILY HOME	FACILITY NUMBER: 565801393
	VISIT DATE: 03/08/2022

NARRATIVE

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During the initial 10-day inspection on 10/29/2021, LPA Lopez and Tri-Counties Regional Center (TCRC) Quality Assurance Specialist (QAS) Liz Aced-Arnett conducted a physical plant tour of the facility and obtained copies of pertinent facility records. The LPA and QAS were informed by Staff #1 (S1) the current census for the home was five residents with three residents currently present in the facility. S1 advised one of the five residents was currently at their day program and the other resident was hospitalized. At 10:45 AM a telephone interview was conducted with Administrator Venie Gonzales.

On 11/02/2021, Investigator Slatic received additional information regarding the investigation. On 12/09/2021, at approximately 9:10 AM, Investigator Slatic conducted an interview with C1. At 10:10 AM, an interview was also conducted with Administrator Venie Gonzales. TCRC QAS, Aced-Arnett, was also present for these interviews. On 12/10/2021, Investigator Slatic contacted the complainant who advised they had no additional complaint information. During the course of the investigation, Investigator Slatic also reviewed relevant facility records.

Interviews and record review revealed C1 had a previous history of sexual abuse by an individual with the same name as I1. Interviews also revealed the facility has 24-hour awake staff with C1 having a private bedroom. Due to C1 having a history of sexually inappropriate behavior in the past, staff also keep an extra eye on C1. Interviews also revealed C2 has a roommate who requires 1:1 supervision for 16 hours a day and there have been no reports of C2 attempting to enter C1’s bedroom or C2 wandering at night. Record review revealed no staff or clients with the same name of I1 reside at the facility. During the interview with C1, C1 only indicated C1 was previously abused. Based on the information obtained, there is insufficient evidence to support the allegation of ‘Client is being sexually abused’. Therefore, the allegation is deemed unsubstantiated at this time.
The allegation of client is being physically abused, alleged C1 had been punched by C2 who is C1’s roommate. During the interview with C1, C1 did not disclose any physical abuse by C2. Interviews also revealed C1 and C2 are not roommates and the increased supervision of C2’s roommate makes its unlikely C2 went into C1’s room without staff knowledge. There are also no reports of C1 having any unexplained injuries. Based on the information obtained, there is insufficient evidence to support the allegation of “Client is being physically abused”. Therefore, the allegation is deemed unsubstantiated at this time.

Report continued on LIC 9099-C.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20211028101812

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: GONZALES FAMILY HOME	FACILITY NUMBER: 565801393
	VISIT DATE: 03/08/2022

NARRATIVE

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It was additionally alleged that the facility is over capacity. It was further reported that nine clients reside in the facility. During the 10/29/2021 physical plant tour, the LPA and QAS observed five resident bedrooms and no staff bedrooms in the facility. Bedroom #1 was single occupancy with one bed, bedroom #2 was double occupancy with two beds, bedroom #3 was single occupancy with one bed, bedroom #4 was currently empty and bedroom #5 was a single occupancy with one bed. During previous visits at the facility unrelated to this complaint investigation on 08/06/2021,08/20/2021, and on 10/06/021, the facility was not operating over capacity. During the interview with the Administrator, they denied operating over capacity. Based on the information obtained there is insufficient evidence to support the allegation of Facility is over capacity. Therefore, the allegation is deemed unsubstantiated.

The Administrator was unable to stay for the entire inspection. The Administrator was advised of the findings prior to leaving the facility.

Exit interview and report reviewed with the staff Rustum Placio. A copy of the report will be emailed.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022

LIC9099 (FAS) - (06/04)

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