565801114-9-23-2023-29-AS-KBUY-CW329T-20230926171227

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801114
Report Date: 09/23/2023
Date Signed: 09/23/2023 09:38:36 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
05/04/2022 and conducted by Evaluator Mark Jeffries

COMPLAINT CONTROL NUMBER: 29-AS-20220504085818

FACILITY NAME:	MANOR OF OJAI, THE		FACILITY NUMBER:	565801114
ADMINISTRATOR:	HALINA GARBACZ		FACILITY TYPE:	740
ADDRESS:	108 W. EUCALYPTUS ST.		TELEPHONE:	(805) 646-1489
CITY:	OJAI	STATE: CA	ZIP CODE:	93023
CAPACITY:	44	CENSUS: 9	DATE:	09/23/2023
		UNANNOUNCED	TIME BEGAN:	07:24 AM
MET WITH:	Halina Garbacz / Administrator		TIME COMPLETED:	09:25 AM

ALLEGATION(S):

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Staff member is verbally abusive towards residents and staff.
Staff member is physically abusive towards residents.
Resident(s) have unexplained bruises/injuries.

INVESTIGATION FINDINGS:

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At 8:00am on 09/23/2023, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to issue final findings of the allegations above to this complaint. LPA met with Administrator and Licensee, Halina Garbacz, who announced who he was and the reason for the visit.
As to the allegation of, “Staff member is verbally abusive towards residents and staff.” It was alleged that a staff member was verbally aggressive to resident(s) on or about May 4th of 2022. Interviews of all Residents on 05/05/2022, Residents 1 (R1), R2, R3, R4, R5, R6, and R7 denied any verbal abuse by any staff at the facility, R1, R3, R4, R5, R6, and R7 all stated that no staff has been rude or has ever hit them at this facility. R2 indicated nonverbally that they have never been hit by staff at this facility. Interviews with Staff 1 (S1) and S2 on 05/05/2022 and 09/16/2023 respectively, stated they have never been rude or hit a resident nor seen or heard of another staff being rude or hit a resident at the facility. Ventura County Sheriff’s report (#2022-58084) dated 05/06/2022, concluded their investigation with “I do not believe there was sufficient evidence leading to (Resident) being a victim of a crime.”
CONTINUED on LIC9099

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2023

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-20220504085818

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: MANOR OF OJAI, THE	FACILITY NUMBER: 565801114
	VISIT DATE: 09/23/2023

NARRATIVE

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At this time, there is not enough evidence to support the allegation of “Staff member is verbally abusive toward residents and staff.” and is unsubstantiated at this time.
As to the allegation of, “Staff member is physically abusive towards residents.” It was alleged that a staff member physically kicked R2, up to 3 times prior to the date or May 4th of 2022. Interviews of all Residents on 05/05/2022, R1, R2, R3, R4, R5, R6, and R7, denied being hit or any verbal abuse by any staff at the facility, R1, R3, R4, R5, R6, and R7 all stated that no staff has ever been rude or has ever hit them at this facility. R2 indicated nonverbally that they have never been hit by staff at this facility. Interviews with Staff 1 (S1) and S2 on 05/05/2022 and 09/16/2023 respectively, stated they have never been rude or hit a resident nor seen or heard of another staff being rude or hit a resident at the facility. Ventura County Sheriff’s report (#2022-58084) dated 05/06/2022, concluded their investigation with “I do not believe there was sufficient evidence leading to (Resident) being a victim of a crime.” At this time, there is not enough evidence to support the allegation of “Staff member is physically abusive toward residents.” and is unsubstantiated at this time.

As to the allegation of, “Resident(s) have unexplained bruises/injuries.” It was alleged that R2 sustained unexplained bruises on their wrists on or before May 4, of 2022. On 05/05/2022 Licensing Program Analyst (LPA) Ascencio did not record any observations of bruises on R2 during that in-person interview. Ventura County Sheriff’s report dated 05/06/2022 indicated that the investigation to the alleged bruising which states,” I checked (Resident) legs, arms and back for any signs of injury or unusual bruising with negative results. (Resident) bedding appeared clean and (they) also appeared to be well taken care of and there were no signs of neglect.” On 09/16/2023 LPA Jeffries conducted a cursory tour of the facility and did not observe any neglect or unusual injuries on the residents that were present. R2 had moved from the facility prior to the visit 09/16/2023 visit. At this time, there is not enough evidence to support the allegation of, ““Resident(s) have unexplained bruises/injuries.” and is unsubstantiated at this time.

Exit interview, report read, and report provided.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2023

LIC9099 (FAS) - (06/04)

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