306002428-5-13-2021-22-AS-SSAS-C3NTKL-20210604144804

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002428
Report Date: 05/13/2021
Date Signed: 05/13/2021 04:01:35 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/19/2021 and conducted by Evaluator Michael Barrett

COMPLAINT CONTROL NUMBER: 22-AS-20210119141639

FACILITY NAME:	FAMILY CARE - EL MAR HOME		FACILITY NUMBER:	306002428
ADMINISTRATOR:	VENANZI, RUSSELL		FACILITY TYPE:	740
ADDRESS:	26542 EL MAR DRIVE		TELEPHONE:	(949) 589-0145
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 4	DATE:	05/13/2021
		UNANNOUNCED	TIME BEGAN:	03:45 PM
MET WITH:	Administrator (AD) Russell Venanzi		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility staff members hit residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Mike Barrett contacted the facility via telephone for the purpose of presenting the findings of the complaint investigation due to COVID 19 and pre-cautionary measures. LPA Barrett identified himself and discussed the findings with Administrator (AD) Russell Vananzi. The following are the findings of the investigation conducted by LPA Barrett, which involved interviews, record review and site observations.
On January 19, 2021, the Community Care Licensing Division, Orange County, received an complaint alleging that facility staff members hit residents. It was reported that Resident #1 (R1) was hit in the face by the facility staff. LPA conducted interviews with R1, Administrator, Staff #1 (S1) and Staff #2 (S2) as well as the Reporting Party (RP). LPA also reviewed documentation from R1's file. It was determined that R1 was struck in the face on the incident report to have occured on 1/18/2021 due to an accident in which S1 was attempting to reach for a TV remote in order to turn the volume down.

Continued on page 2.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Michael Barrett
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2021

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 22-AS-20210119141639

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: FAMILY CARE - EL MAR HOME	FACILITY NUMBER: 306002428
	VISIT DATE: 05/13/2021

NARRATIVE

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R1 was upset and had turned the volume of the TV to a loud setting and was asked to turn down the volume. R1 refused to turn down the volume and so S1 attempted to reach for the remote to turn it down, as it was a disruption to the rest of the facility and other residents in care. During the attempt R1 pulled the remote control away from S1 and accidentally struck himself in the face causing a bruise. Interviews revealed that R1 had told the RP that he was struck because R1 was feeling agitated and stated in the interview that it was not true. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

There are no deficiencies being cited for this investigation.

An exit interview was conducted with the Administrator (AD), Russell Venanzi, and a hard copy of this report was emailed to AD for signatures.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Michael Barrett
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2021

LIC9099 (FAS) - (06/04)

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