561703573-1-6-2023-29-AS-DPEA-CNLTPG-20230131135417

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 561703573
Report Date: 01/06/2023
Date Signed: 01/06/2023 04:27:20 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
12/30/2022 and conducted by Evaluator Emily Peraldi

COMPLAINT CONTROL NUMBER: 29-AS-20221230145649

FACILITY NAME:	ELMS RESIDENTIAL CARE		FACILITY NUMBER:	561703573
ADMINISTRATOR:	HIGGINS, FE LILIA 98		FACILITY TYPE:	740
ADDRESS:	67 EAST BARNETT		TELEPHONE:	(805) 643-2176
CITY:	VENTURA	STATE: CA	ZIP CODE:	93001
CAPACITY:	54	CENSUS: 42	DATE:	01/06/2023
		UNANNOUNCED	TIME BEGAN:	09:51 AM
MET WITH:	Fe Higgins		TIME COMPLETED:	04:35 PM

ALLEGATION(S):

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Neglect and lack of supervision resulted in a resident injuring another resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Emily Peraldi arrived unannounced for an initial 10-day visit. At 9:51 a.m., the LPA met with staff and the Administrator Fe Higgins and explained the reason for the visit.

At 10:09 a.m., the LPA conducted an interview with the Administrator. At 10:14 a.m., the LPA along with staff toured the facility. Between 10:21 a.m. and 11:32 a.m., the LPA interviewed three (3) staff and seven (7) residents. At 12:00 p.m., the LPA obtained pertinent documents. At 2:39 p.m., the LPA interviewed the resident’s social worker. At 3:57 p.m., the LPA attempted to interview Individual #1 (I1).

Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023

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-20221230145649

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: ELMS RESIDENTIAL CARE	FACILITY NUMBER: 561703573
	VISIT DATE: 01/06/2023

NARRATIVE

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Regarding the allegation: Neglect and lack of supervision resulted in a resident injuring another resident.
It was alleged that Resident #1 (R1) had an altercation with another resident which resulted in R1 being injured. It was alleged that another resident began to verbally antagonized R1 and R1 responded by physically attacking the resident. The resident fought back with keys which left bruises and scratches on R1’s arm. Conflicting information was obtained during residents and staff interviews. R1 did not want to disclose whom R1 had an altercation with. R1 also refused to speak about the altercation to the LPA. Interviews with staff revealed that there has not been an altercation between R1 and another resident. However, interviews with staff revealed that staff did hear and intervene an argument with R1 and a temporary staff, Individual #1 (I1) regarding R1’s laundry. Staff interviews revealed that Staff #1 (S1) heard the argument and immediately intervened and defused the situation. Staff stated the altercation was a minor argument, not a physical altercation. Staff stated that the argument occurred two weeks ago, but staff could not provide a specific date. Staff interviews revealed that I1 was working at the facility as housekeeping and was only doing laundry. Staff interviews revealed that R1 and I1 resolved the laundry issue and were friendly with each other after the argument. Staff interviews revealed that as of recently there has not been physical fights or major altercations among the residents at the facility.

Interview conducted with R1’s social worker revealed that R1 refused to speak about the altercation and refused to name the resident whom injured R1. R1’s social worker stated that they did observe R1’s bruises and scratches on R1’s arm. R1’s social worker stated that R1does have a temper and has previously argued with staff at previous facility, not current the one.

Interviews with residents revealed that there has not been recent fights or altercations at the facility. Residents stated that when arguments occur that staff do intervene and de-escalate the situation. Additionally, interviews with residents revealed that overall residents feel safe and well taken care of at the facility. Residents did not express any immediate or major concerns regarding lack of supervision. Residents stated that staff are friendly. No issues or concerns regarding staff were brought up during resident interviews.
The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. 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 deemed Unsubstantiated at this time. Exit interview conducted. A copy of the report was issued via email.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023

LIC9099 (FAS) - (06/04)

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