565801728-9-30-2021-29-AS-DPEA-CDANV3-20220408104717

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801728
Report Date: 09/30/2021
Date Signed: 09/30/2021 06:28:20 PM

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
08/03/2020 and conducted by Evaluator Kasandra Lopez

COMPLAINT CONTROL NUMBER: 29-AS-20200803140639

FACILITY NAME:	SEA BREEZE MANOR		FACILITY NUMBER:	565801728
ADMINISTRATOR:	ROSE MARIE LOPEZ		FACILITY TYPE:	740
ADDRESS:	1511 OFFSHORE STREET		TELEPHONE:	(805) 985-5995
CITY:	OXNARD	STATE: CA	ZIP CODE:	93035
CAPACITY:	6	CENSUS: 5	DATE:	09/30/2021
		UNANNOUNCED	TIME BEGAN:	01:58 PM
MET WITH:	Rose Marie Lopez and Hermi Gonzales		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Resident's needs are not being met.
Staff handle resident(s) in a rough manner.
Staff has not received proper training

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced subsequent complaint inspection at the facility today beginning at 1:58 PM. When the LPA arrived there were two caregivers and five residents present. Administrators Rose Marie Lopez and Hermi Gonzales arrived at approximately 2:20 PM.

During today's inspection the LPA conducted record review beginning at 2:15 PM, conducted an interview with Resident #2 (R2) at 2:43 PM and interviews with Staff #1 (S1) and Staff #2 (S2) beginning at 2:50 PM. The remaining residents in the home were unable to be interviewed due to their impairments. The LPA was informed during the inspection that Resident #1 (R1) no longer resides at the facility. At 4:32 PM the hot water temperature in the hallway bathroom measured at 111.2 degrees F.

The allegation of 'Resident's needs are not being met' alleges R1 needs were not being met at night and R1's calls for assistance were ignored. Report continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021

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-20200803140639

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: SEA BREEZE MANOR	FACILITY NUMBER: 565801728
	VISIT DATE: 09/30/2021

NARRATIVE

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Interviews with staff revealed R1 only needed assistance one to two times a week and their request for help were always met. Staff stated R2 requests assistance every night and they are always assisted.

The interview with R2 revealed their request for assistance at night are met consistently. Based on the information obtained, there is insufficient evidence to support the allegation of 'Resident's needs are not being met', therefore the allegation is deemed unsubstantiated at this time.

The allegation of Staff handle resident(s) in a rough manner alleges a resident, name unknown was handled roughly and inappropriately by Staff #2 (S2) and S2 used cold water when washing the resident. Interviews with R2 revealed no issues or concerns regarding how staff treat the resident or when washing the resident. S1 and S2 denied handling any residents roughly or using cold water when bathing or washing the residents. Hot water was also measured to be within the required temperature. Based on the information obtained, there is insufficient evidence to support the allegation of 'Staff handle resident(s) in a rough manner', therefore the allegation is deemed unsubstantiated at this time.

The allegation of Staff has not received proper training alleges S1 and S2 have not been trained properly. Record review revealed S1 and S2 began employment at the facility in September 2019 and received 40 hours of training within the first four weeks of hire and received required medication training. S1 and S2 also had current first aid and CPR training at the time the complaint was filed. Interviews with S1 and S2 also revealed they received training when hired. At the time the complaint was filed, staff met the training requirements pursuant to Regulations and the Health and Safety code. Therefore, the allegation of 'Staff has not received proper training' is deemed unsubstantiated at this time.

A deficiency observed during record review will be cited under a separate report.

Exit interview and report reviewed with Hermi Gonzales and Rose Marie Lopez. Rose Marie Lopez signed the report. A copy of the report and appeal rights will be emailed.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021

LIC9099 (FAS) - (06/04)

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