565801925-7-2-2025-29-AS-KHEN-DJZSQC-20250728140427

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801925
Report Date: 07/02/2025
Date Signed: 07/02/2025 02:00:20 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
07/03/2024 and conducted by Evaluator Emily Peraldi

COMPLAINT CONTROL NUMBER: 29-AS-20240703092606

FACILITY NAME:	ABUTIN CARE HOME III		FACILITY NUMBER:	565801925
ADMINISTRATOR:	BENJAMIN G. ABUTIN JR.		FACILITY TYPE:	735
ADDRESS:	3100 OARFISH LANE		TELEPHONE:	(805) 984-8287
CITY:	OXNARD	STATE: CA	ZIP CODE:	93035
CAPACITY:	6	CENSUS: 6	DATE:	07/02/2025
		UNANNOUNCED	TIME BEGAN:	01:26 PM
MET WITH:	Benjamin G. Abutin		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Client sustained an injury while in care.
Staff did not seek medical treatment in a timely manner.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced subsequent complaint visit at this facility today. At 1:26 p.m., the LPA met with facility staff and explained the reason for the visit. At 1:40 p.m., the Administrator, Benjamin G. Abutin arrived at the facility.

During the initial visit on 07/03/2024 between 10:35 a.m. and 12:10 p.m., the LPA conducted a physical plant tour and an interview with the Administrator, Joyce A. The LPA also requested and obtained copies of pertinent documents. During today’s visit, the LPA conducted interviews with the Administrator, Client #1 (C1) and one (1) staff.

Regarding the allegations:1.) Client sustained an injury while in care. 2.) Staff did not seek medical treatment in a timely manner. On 07/03/2024, the Department received a complaint alleging that Client #1 (C1) sustained an injury on hip and that staff did not seek medical treatment in a timely manner.Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025

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-20240703092606

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ABUTIN CARE HOME III	FACILITY NUMBER: 565801925
	VISIT DATE: 07/02/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Interview conducted with the Administrator, Joyce Abutin revealed that C1 has been having ambulatory issues and has become more at risk of falling in the past six (6) months. The Administrator, Joyce A. explained that herself and staff have been monitoring C1 closely as C1 has had falls. Per record review and interview, C1 is diagnosed with chronic severe osteoarthritis on both knees however with the right knee being more severe. On 06/09/2024, Joyce A. submitted two (2) incident reports regarding C1, 06/07/2024 while at the day program C1 had a fall and possibly hit C1's leg, and a second fall occurred at the facility on 06/09/2024. Incident reports indicated that C1 had no acute pain or discomfort and that C1 had an appointment scheduled for 06/10/2024 with an orthopedic specialist to evaluate the need for knee surgery. On 06/17/2024, Joyce A. submitted an incident report of an incident that occurred on 06/16/2024 describing C1 dropping to the floor as C1 believed they saw a ghost. The incident report noted staff noticing bruising on C1’s legs and dark discoloration around the right hip area. It was also noted that C1 denied any pain or discomfort. On 06/20/2024, Joyce A. submitted an incident report for C1 being found on the floor on 06/20/2025 by staff, as C1 fell attempting to use the commode. Incident reports noted that C1 was reminded and encouraged to ask staff for assistance when needing to use the restroom. On 06/25/2024, Joyce A. submitted an incident report regarding C1 having stiff legs, dropping themselves and having pain. The incident report indicated that staff called 911 and C1 was sent to the Emergency Room (ER) and later transferred to the hospital. Interview with Joyce A. revealed that C1 was admitted to the hospital for distal femur fracture and had surgery on 06/28/2024 and afterwards was admitted to a Skilled Nursing Facility (SNF) for rehabilitation. Joyce A. stated that she visited C1 at the SNF and that C1’s condition has improved. Joyce A. explained that prior to C1’s hospitalization, she has been taking C1 to frequent doctor visits regarding C1’s condition and recent falls. Per record review, C1 had doctors’ visits on 05/01/2024, 05/08/2024, 05/23/2024, 06/10/2024 and 06/24/2024. Interviews and record reviews indicated that C1 would often throw themselves to the floor or would not ask staff for assistance when needing to use the restroom causing C1 to fall and sustain injuries. Interview with C1 revealed that C1 has no concerns regarding staff and is content at the facility. Interview with Administrator Benjamin G. Abutin revealed that C1 has not had any recent falls and has been asking for assistance when needed. The information obtained during the investigation did not include evidence sufficient to corroborate the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are deemed Unsubstantiated at this time.

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

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2