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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801393
Report Date: 07/13/2023
Date Signed: 07/13/2023 04:25:28 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
03/08/2023 and conducted by Evaluator Kasandra Lopez
COMPLAINT CONTROL NUMBER: 29-AS-20230308143647
FACILITY NAME:GONZALES FAMILY HOMEFACILITY NUMBER:
565801393
ADMINISTRATOR:VENIE G. GONZALESFACILITY TYPE:
735
ADDRESS:4450 BROWNING DRIVETELEPHONE:
(805) 488-2315
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:6CENSUS: 6DATE:
07/13/2023
UNANNOUNCEDTIME BEGAN:
03:03 PM
MET WITH:Venie GonzalesTIME COMPLETED:
04:35 PM
ALLEGATION(S):
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Staff hit client
Staff did not treat client with dignity and respect
Staff failed to assist client
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced subsequent complaint inspection today at the facility regarding the above allegations. The LPA initially met with staff and explained the reason for the inspection. Administrator Venie Gonzales arrived shortly after the inspection began.

The investigation for the complaint alleges began on 03/10/2023. During this visit the LPA conducted a brief physical plant tour, interviewed one client at 10:09 AM, and interviewed two staff members.

During today's inspection the LPA conducted two staff interviews between 3:06 PM and 3:15 PM and with Client #1 (C1) at 3:45 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: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
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 2
Control Number 29-AS-20230308143647
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: 07/13/2023
NARRATIVE
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The allegations of 'Staff hit client', 'Staff did not treat client with dignity and respect', and "Staff failed to assist client' alleges Staff #1 (S1) punched C1 in the face and S1 was angry, swearing and flipping off C1. It was also alleged that various staff members witnessed the incident and did not intervene.

A review of the staff roster and list of staff currently associated to the facility revealed no staff member with the same name as S1. Interviews with the Administrator, facility staff and one client also confirmed no one with S1's name works at the facility.

Record review revealed on 02/22/2023, C1 and another client in the home, Client #2 (C2) had an altercation where both clients pushed each other. C2 has the same name as the alleged S1. Staff interviews and record review revealed staff intervened and separated the two clients after the incident occurred. On 03/02/2023, C1 and C2 had another altercation of which C1 was hit by C2. Staff intervened again and separated the two clients. Both incidents resulted in no injuries. Staff interviews revealed staff do their best to intervene and de-escalate the situation when any clients in the home have altercations and denied ever not intervening.

Based on the information obtained, there is insufficient evidence to support the allegations of staff hit client, staff did not treat client with dignity and respect, and staff failed to assist client occurred. Therefore, the allegations are deemed unsubstantiated at this time.

The complaint findings were reviewed with the Administrator. The Administrator gave permission for staff to sign the report.

Exit interview conducted. A copy of the report and appeal rights provided.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
LIC9099 (FAS) - (06/04)
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