565801764-6-24-2020-31-AS-MVAO-BQWNSC-20200625104252

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801764
Report Date: 06/24/2020
Date Signed: 06/24/2020 12:21:13 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE. SUITE 200
GOLETA, CA 93117

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/13/2020 and conducted by Evaluator Mita Amin

COMPLAINT CONTROL NUMBER: 31-AS-20200413155258

FACILITY NAME:	HAPPY HOME CARE II		FACILITY NUMBER:	565801764
ADMINISTRATOR:	MICHAEL ROSALES		FACILITY TYPE:	740
ADDRESS:	1273 SHEFFIELD PLACE		TELEPHONE:	(805) 371-7801
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	6	CENSUS: 3	DATE:	06/24/2020
		UNANNOUNCED	TIME BEGAN:	10:38 AM
MET WITH:	Karen Rosales		TIME COMPLETED:	11:54 AM

ALLEGATION(S):

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-A resident's personal rights were violated.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mita Amin initiated a subsequent complaint visit for the purpose of delivering findings for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint visit was conducted telephonically with Karen Rosales.

It is alleged that the Staff #1 (S1) inappropriately touched the resident #1 (R1) while providing hygiene care.

To investigate this allegation, LPA conducted interviews with the facility administrator on 4/14/20 at 11 am. The phone interview was conducted with the caregivers Staff#1(S1) and Staff#2(S2) on 6/17/20 at 3:39 pm.
On 6/17/20 R1 was interviewed via phone at 2:40 pm. On 4/22/20, LPA obtained the copy of the Ventura County Sheriff’s Department’s police report, reviewed on 4/29/2020 at 3 PM.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Mita Amin	TELEPHONE: (818) 241-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2020

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 31-AS-20200413155258

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE. SUITE 200
GOLETA, CA 93117

FACILITY NAME: HAPPY HOME CARE II	FACILITY NUMBER: 565801764
	VISIT DATE: 06/24/2020

NARRATIVE

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Based on the review of the report, on 4/11/20, Officer made a visit to the above facility to conduct the investigation. Officer interviewed the resident#1(R1) first and than interviewed caregivers, staff#1(S1) and staff#2(S2). During the interview, R1 expressed that S1 is being rough when cleaning, but did not believe that is sexual in nature. The report reflects that based on their observation and interviews law enforcement could not establish the crime, however believed that R1 was just not happy with male caregiver providing the hygiene care.

LPA learned during the investigation that above facility has a live-in caregivers, husband and wife for long time. Interview with the administrator revealed that there is no complaint or concerns that she is aware of this nature. They were surprised when the officer visited the facility and heard of the allegation first time. She stated, R1 moved in the facility on 3/28/20, did not complaint or raise the concern about receiving care from male caregivers to anyone at the facility or to her. Because R1 being on heavy side it was easier for male caregiver. However if they would have known that resident#1(R1) prefers female staff, they could have arranged that easily.

Interview with S2, revealed that normally she cares for female residents and S1 cares for male residents, but it's not always possible, specially in case of emergency. Now they are making sure female caregiver to provide care to R1 and make sure to ask for the permission before providing care to the opposite sex, if that is fine with them.

S1 denied any inappropriate touching or behavior while proving care to R1. S1 added that he did not see any indication of rejection of services or uncomfortableness while proving care to R1. S2 can't take care of R1 alone, because R1 is heavy and she needs S1's help.

On 6/17/20 @ 2:40 pm, LPA spoke with R1 via phone and was informed that he/she is happy with the care they are proving and have no concern or complaint.

Based on the information obtained during this investigation, there is an insufficient evidence to support the allegation that “A resident's personal rights were violated. “ Therefore, the above allegation is deemed unsubstantiated at this time. No deficiencies cited at this time. A telephonic exit interview was conducted with Ms. Resales, and a hard copy was provided via email for signature.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Mita Amin	TELEPHONE: (818) 241-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2020

LIC9099 (FAS) - (06/04)

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