565850108-5-8-2024-29-AS-DPEA-D5HU2H-20240522151159

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850108
Report Date: 05/08/2024
Date Signed: 05/08/2024 02:57:08 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
05/02/2024 and conducted by Evaluator Teresa Camara

COMPLAINT CONTROL NUMBER: 29-AS-20240502091135

FACILITY NAME:	OAK PLACE RESIDENTIAL CARE		FACILITY NUMBER:	565850108
ADMINISTRATOR:	SPRING, BECKY		FACILITY TYPE:	740
ADDRESS:	50 OAK ST.		TELEPHONE:	(805) 586-4086
CITY:	CAMARILLO	STATE: CA	ZIP CODE:	93010
CAPACITY:	36	CENSUS: 36	DATE:	05/08/2024
		UNANNOUNCED	TIME BEGAN:	09:41 AM
MET WITH:	Flordeliza "Baby" Hipolito		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff intimidates residents
Staff blocks residents from coming and going
Facility failed to safeguard resident's personal property

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Teresa Camara conducted a complaint investigation visit regarding the above noted allegations. LPA met with back-up administrator Flordeliza "Baby" Hipolito and explained the reason for the visit.

LPA conducted an interview with the administrator at 9:46 a.m., record review at 10:00 a.m., facility tour at 10:20 a.m., and interviews with staff and clients from 10:38 a.m. to 12:37 p.m.

The administrator stated the name of the alleged staff intimidating residents is actually a resident at the facility and not a staff. LPA interviewed the alleged victim, resident 1 (R1), who voiced no complaints or concerns regarding staff or missing items. R1 explained in the past, under previous facility owners, R1 had a roommate who would take their shoes but with the help of the administrator that was worked out.

(continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

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-20240502091135

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: OAK PLACE RESIDENTIAL CARE	FACILITY NUMBER: 565850108
	VISIT DATE: 05/08/2024

NARRATIVE

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(continued from LIC9099)

R1 stated there are some other residents with habits R1 would prefer they did not do but R1 understand they must live with roommates and compromise is necessary sometimes.

LPA also spoke with the alleged perpetrator resident 2 (R2) who did not wish to talk with LPA for very long. R2 is reasonably happy at the facility. R2 prefers to stay on their own and not participate in activities or go out. LPA initially observed R2 in the backyard smoking area staying in an area away from other residents.

Interviews with staff were conducted. Staff have not witnessed any residents or other staff intimidating residents or blocking their path. The administrator and one staff said R2 walks around the facility most of the day and sometimes if R2 is in the hall they may be blocking the hallway so staff just say, "excuse me" and R2 moves. R2 is not aggressive in any way and will politely move. Staff have never received any complaints from residents about missing items. One staff recalled a resident missing their wallet but it was found in that resident's drawer a couple days later.

Interviews with other residents were conducted. The residents are happy at the facility. They like the food. They like the quality of the food they get under the facility's new ownership. They have never felt intimidated by other residents or staff and have never had their pathway blocked by others. They have never had any missing items.

Based on interviews with staff and residents, the allegations "Staff intimidates residents", "Staff blocks residents from coming and going", and "Facility failed to safeguard resident's personal property" are deemed Unsubstantiated at this time.

No deficiencies observed. Exit interview conducted and a copy of the report issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

LIC9099 (FAS) - (06/04)

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