561703573-3-16-2023-29-AS-DPEA-CQDUQ6-20230329154638

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 561703573
Report Date: 03/16/2023
Date Signed: 03/16/2023 05:51:55 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 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
03/09/2023 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20230309082349

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:	03/16/2023
		UNANNOUNCED	TIME BEGAN:	02:29 PM
MET WITH:	Fe Higgins		TIME COMPLETED:	05:55 PM

ALLEGATION(S):

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Staff do not provide adequate meal service to residents in care.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Kasandra Lopez and Esther Cortez arrived at the facility unannounced to conduct an initial complaint visit at 2:29p.m. When the LPAs arrived, they met with staff member Angelina Perez and explained the reason for the visit. Met with Administrator Fe Higgins shortly after and explained the reason for the visit as well.

During todays inspection, the LPAs and Administrator toured the Kitchen and food storage area between 2:30 p.m. – 2:45 p.m., obtained documents at 2:46 p.m., and the LPAs interviewed (7) seven residents between 2:47 p.m., and 3:14p.m.

Report will continue on LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

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-20230309082349

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ELMS RESIDENTIAL CARE	FACILITY NUMBER: 561703573
	VISIT DATE: 03/16/2023

NARRATIVE

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The allegation of ‘Staff do not provide adequate meal service to residents in care’ alleges that the food is served cold, and residents are not receiving a variety of fruits, vegetables, and breakfast food items. During the inspection, LPAs observed a sufficient supply of perishable/non-perishable foods except for fresh fruits. LPAs observed approximately six (6) bananas, one (1) mango and one (1) watermelon for a census of forty-two (42) residents. Interviews with Residents revealed residents are not receiving fresh fruit everyday and are receiving Jello in lieu of fruit. Four of seven residents interviewed stated they occasionally receive their food cold or at least part of their meal cold. During the interviews, residents had no complaints regarding breakfast meals, or the variety of breakfast items being served and there was insufficient evidence to support the residents are not receiving a sufficient supply of vegetables.

Based on the information obtained, there is sufficient evidence to support the allegation of ‘Staff do not provide adequate meal service to residents in care’ as the facility did not have a sufficient supply of perishable fruit and residents interviewed also confirmed they do not receive fresh fruit every day.

The following deficiencies were observed (See LIC 9099-D.) and cited from the CA Code of Regulations, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted and report reviewed with administrator Fe Higgins. A copy of the report and appeal rights were provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230309082349

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ELMS RESIDENTIAL CARE	FACILITY NUMBER: 561703573
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/16/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/23/2023 Section Cited CCR 87555(b)(26)	1 2 3 4 5 6 7	87555 General Food Service Requirements (b)(26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met as evidence by:	1 2 3 4 5 6 7	Licensee agrees to submit proof of sufficient perishable fruit supply by Thursday 3/23/23.
	8 9 10 11 12 13 14	Based on observation and interview, the licensee failed to comply with the section cited above as the facility did not have sufficient supply of perishable fruit, which poses a potential health risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

LIC9099 (FAS) - (06/04)

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