565850274-7-12-2023-29-AS-DPEA-CU2TZ6-20230724150948

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850274
Report Date: 07/12/2023
Date Signed: 07/12/2023 05:44:16 PM

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
04/27/2023 and conducted by Evaluator Kelly Dulek

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20230427144838

FACILITY NAME:	PETIT OASIS		FACILITY NUMBER:	565850274
ADMINISTRATOR:	VINCECRUZ, SUSAN		FACILITY TYPE:	740
ADDRESS:	2802 PETIT STREET		TELEPHONE:	(805) 383-8894
CITY:	CAMARILLO	STATE: CA	ZIP CODE:	93012
CAPACITY:	6	CENSUS: 3	DATE:	07/12/2023
		UNANNOUNCED	TIME BEGAN:	04:38 PM
MET WITH:	Roberto Ramirez		TIME COMPLETED:	05:53 PM

ALLEGATION(S):

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Facility is not kept free of hazards
Residents are not provided proper accommodations

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint investigation for the allegations listed above. LPA arrived at the facility at 04:38PM and met with facility staff. Licensee Roberto Ramirez was contacted via telephone and arrived at 04:58PM. Entrance interview conducted.

During a previous unrelated visit conducted on 07/05/2023, LPA interviewed residents from 03:05PM to 03:24PM and conducted a facility tour at 12:03PM. During an initial visit conducted on 05/03/2023, LPA interviewed Licensee at 10:25AM, toured the facility with Licensee at 10:53AM, and obtained copies of pertinent documents. The following was then determined:

The complaint alleges that the facility is not kept free of hazards, relating to the backyard pool containing standing water as well as front and back ramps containing impediments. During the initial complaint visit,
Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023

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-20230427144838

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: PETIT OASIS	FACILITY NUMBER: 565850274
	VISIT DATE: 07/12/2023

NARRATIVE

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Continued from LIC 9099

LPA observed and took photographs of the pool. Licensee indicated the pool’s pump had broken, the new parts were purchased, and pool repair had begun, but were not yet completed at the time of the initial visit. The Licensee showed LPA that the drainage hose was connected but that the Licensee was draining the water out slowly as to not create runoff in the neighboring properties. The water contained in the pool did appear dirty, however, LPA did not observe any mosquitos or other pests in or around the standing water. Although the pool was unusable in the observed condition, the pool remained inaccessible to residents in care, by use of a surrounding fence and locked gate. Interviews with residents confirmed the pool is inaccessible at all times and no pests were observed in the backyard area. At the unrelated visit on 07/05/2023, LPA observed the pool to be full of clean water and the pool pump and filter systems appeared to be functional. Regarding the ramps, during the initial complaint visit, LPA observed and measured the facility ramps, rise of the ramps, as well as the gaps observed in the front ramp. LPA took photos of the ramps and exit paths for the residents. During the unrelated visit on 07/05/2023, LPA interviewed residents regarding the ramps and exit paths. Resident #1 (R1) indicated that the Licensee did recently repair the ramps to ensure easier access and a smoother terrain, however, R1 stated they have used the back ramp to exit the building without issue since they moved into the facility. Interviews revealed that residents are able to use the ramps and passageways with no concerns or incidents. Additionally, LPA contacted the local fire inspector to inquire about exterior ramp requirements. Documentation provided to the LPA indicated California Building Code (CBC) relating to ramps in group R-3.1 occupancies (Residential Care Facilities for 6 or fewer clients) “does not require changes in level for the exterior to be made by means of a ramp,” therefore there are no fire department requirements related to the facility’s exterior ramps. Based on interview and observation, although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that “Facility is not kept free of hazards” is deemed UNSUBSTANTIATED at this time.

The complaint also alleges that the Licensee did not provide proper accommodations relating to the doorways not being wide enough to accommodate Resident #1 (R1)'s wheelchair. It was observed that R1 has an extra-wide wheelchair. LPA reviewed R1’s physician’s report and corresponding documentation, which revealed that R1 uses a walker to ambulate, not a wheelchair. Additionally, there were no doctor’s orders found indicating R1 requires an extra wide wheelchair. R1 indicated that they are able to use either of their 2 (two) walkers to exit their bedroom and enter the restroom. LPA measured all doorways in the facility and

Report Continued on LIC 9099-C

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230427144838

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: PETIT OASIS	FACILITY NUMBER: 565850274
	VISIT DATE: 07/12/2023

NARRATIVE

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observed another resident utilizing a wheelchair to ambulate throughout the facility. LPA contacted the fire inspector to ensure doorway width does not affect the facility’s fire clearance. Fire inspector indicated that the fire department does not have width requirements for interior doors, and therefore the door width does not affect the facility’s fire clearance. In the event of an emergency, R1’s exit route is through the back slider in their room, which is sufficiently wide to accommodate R1’s wheelchair. Based on interview, record review, and observation, although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that “residents are not provided proper accommodations” is deemed UNSUBSTANTIATED at this time.

No deficiencies issued. Exit interview conducted. A copy of the report was provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023

LIC9099 (FAS) - (06/04)

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