565801924-3-6-2023-29-AS-DPEA-CQ7UHP-20230323153616

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801924
Report Date: 03/06/2023
Date Signed: 03/06/2023 10:03:15 AM

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
12/05/2022 and conducted by Evaluator Martha Arroyo

COMPLAINT CONTROL NUMBER: 29-AS-20221205121618

FACILITY NAME:	ABUTIN CARE HOME II		FACILITY NUMBER:	565801924
ADMINISTRATOR:	BENJAMIN G. ABUTIN JR.		FACILITY TYPE:	735
ADDRESS:	1830 W. HILL STREET		TELEPHONE:	(805) 985-4832
CITY:	OXNARD	STATE: CA	ZIP CODE:	93035
CAPACITY:	6	CENSUS: 6	DATE:	03/06/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Benjamin Abutin Jr.		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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Facility staff hit resident on face
Facility staff handled resident roughly
Facilty staff yelled at resident
Facility staff used medication as a restraint

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs), Martha Arroyo and Esther Cortez conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above allegations. The initial visit was conducted on 12/12/2022 by LPA M. Arroyo. On today’s visit, LPAs Arroyo and Cortez met with the Administrator, Benjamin Abutin Jr. Entrance interview conducted.

During the initial visit on 12/12/2022, LPA Arroyo conducted interviews with the administrator, three staff, three residents, and one family member between 10:05 am and 11:35 am. At 10:27 am, LPA conducted a record review and obtained copies of client records, staff records, and other pertinent documents relevant to the investigation.

Report Continued on LIC 809C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

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-20221205121618

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: ABUTIN CARE HOME II	FACILITY NUMBER: 565801924
	VISIT DATE: 03/06/2023

NARRATIVE

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Report Continued from LIC 809...

It was alleged that facility staff yelled at resident and facility staff hit resident on face. It was reported that staff yelled at Resident #1 and then proceeded to hit R1 on both face cheeks. Information gathered revealed that there has not been any residents report being hit or abused by any staff. In addition, residents can communicate with staff at any time if they feel uncomfortable. Interviews conducted with R1’s family revealed that they often visit R1 at the facility and also communicate well with both staff and residents. Additionally, R1’s family stated if at any moment they felt R1 was in any danger they would have taken R1 out of the facility by now. Interviews conducted with residents revealed residents have often witnessed other residents yell or hit staff; however, they have never witnessed the staff yell or hit any of the residents back. Furthermore, R1 stated facility staff have never hit them and denied any physical abuse while living at the facility. Based on information gathered during the course of the investigation, there is insufficient evidence to support the allegations, “facility staff yelled at resident” and “facility staff hit resident on face”. Therefore, these allegations are deemed Unsubstantiated at this time.

It was also alleged that facility staff handled resident roughly. It was reported that staff grabbed R1 by the wrists and put them behind R1. Interviews conducted with staff revealed residents tend to get physical when they have behavioral outburst but denied reciprocating the same behavior towards residents. Additionally, residents admitted they have at times physically hit the staff, but the staff do not react the same and keep their hands to themselves. Interviews conducted with R1’s family revealed that they do not feel R1 is in danger while at the facility and feel the staff is amazing when it comes to how they treat R1. Furthermore, residents did not report any abuse or complaints from facility staff. Based on interviews conducted with staff, residents, and family members, there is insufficient evidence to support the allegation of “facility staff handled resident roughly.” Therefore, this allegation in deemed Unsubstantiated at this time.

It was further alleged that facility staff used medication as a restraint. It was reported that staff gave R1 medication to make R1 go to sleep. Record review of R1’s centrally stored medication log revealed R1 has a PRN prescription for acetaminophen 500mg, 2 tablets twice a day as needed for pain medication. Interviews conducted with staff revealed that R1 had been displaying signs of being in pain. Staff called the Administrator to report R1’s behavior and state that they were going to give R1 acetaminophen for the pain.

Report Continued on LIC 809C...

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20221205121618

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: ABUTIN CARE HOME II	FACILITY NUMBER: 565801924
	VISIT DATE: 03/06/2023

NARRATIVE

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Report Continued from LIC 809C...

Staff stated reporting to the Administrator prior to administering the PRN to R1 as per their protocol, they are required to communicate with the Administrator before administering PRN’s to any residents to make sure that it is logged properly on the centrally stored medication log. Additionally, record review noted R1’s last medication administered on the day in question was 2 tablets of acetaminophen. Based on the information and records obtained and reviewed, there is insufficient evidence to support the allegation of “facility staff used medication as a restraint.” Therefore, this allegation is deemed Unsubstantiated at this time.

Exit interview conducted. No citations issued. Report was reviewed and a copy was issued to the Administrator.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

LIC9099 (FAS) - (06/04)

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