565801393-6-26-2023-29-AS-DPEA-CTAUQ5-20230630154633

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801393
Report Date: 06/26/2023
Date Signed: 06/26/2023 12:01:39 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
06/22/2023 and conducted by Evaluator Kasandra Lopez

COMPLAINT CONTROL NUMBER: 29-AS-20230622110504

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: 6	DATE:	06/26/2023
		UNANNOUNCED	TIME BEGAN:	09:34 AM
MET WITH:	Venie Gonzales		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

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Client is being physically abused by other clients in the home
Client's mouth was covered by another client while they were sleeping

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced initial complaint inspection at the facility today regarding the above allegations. Tri-Counties Regional Center Quality Assurance Specialist (QAS) Liz Aced-Arnet was also present. The LPA met with staff initially and explained the reason for the inspection. Administrator Venie Gonzales arrived at the facility at 10:43 AM.

During the today's inspection the LPA reviewed facility records and conducted interviews with the Administrator, three staff members, one of which works the overnight shift, and Client #2 (C2) between 10:33 AM and 11:20 AM. Client #1 (C1) was unavailable to be interviewed today and Client #3 (C3) was unable to be interviewed due to their disabilities. A tour of the facility revealed C1 has a functioning alarm on their bedroom door that rings when the door is opened.

Report continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023

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-20230622110504

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: 06/26/2023

NARRATIVE

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Allegation: Client is being abused by other clients in the home

The allegation alleges C1 is being hit by C2 and C3 and recently had a glass thrown at them by C2. Record review and daily notes reviewed revealed no written documentation of C1 being hit or having anything thrown at C1 by C2 or C3. Interviews with staff and the Administrator revealed no observation of C2 or C3 being physically aggressive with C1 or with anyone else in the home and denied observing C2 throw anything at C1. During the interview with C2, C2 denied ever hitting C1 or throwing anything at C1.

Based on the information obtained there is insufficient evidence to support the allegation occurred. Therefore, the allegation of Client is being abused by other clients in the home is deemed unsubstantiated at this time.

Allegation: Client's mouth was covered by another client while they were sleeping

The allegation alleges C2 and C3 comes into C1's room at night and bothers C1 and covers C1's mouth when C1 is trying to sleep. Due to prior allegations of abuse happening at night, C1 has an alarm on their bedroom door to monitor when C1 comes in or out of their bedroom and to ensure no other client enter C1's bedroom at anytime. Staff interviewed stated they have not observed any clients entering or attempting to enter C1's room at anytime. During the interview with C2 they denied ever going into C1's bedroom. Based on the information obtained there is insufficient evidence to support the allegation occurred. Therefore, the allegation of Client's mouth was covered by another client while they were sleeping is deemed unsubstantiated at this time.

Exit interview conducted. A copy of the report was provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023

LIC9099 (FAS) - (06/04)

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