561703573-6-23-2023-29-AS-DPEA-CTXURD-20230721154832

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 561703573
Report Date: 06/23/2023
Date Signed: 06/23/2023 04:31:08 PM

Unsubstantiated

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
06/21/2023 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20230621094948

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:	06/23/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Fe Higgins		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility has an infestation of bed bugs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced initial 10-Day complaint visit to the facility at 01:00 p.m. The LPA met with Designee Percy Tabing and discussed the reason for the visit. Administrator Fe Higgings arrived shortly after and was informed of the reason for the visit.

During today's visit the LPA toured the facility with designee Percy between 1:25 p.m. and 2:30 p.m. and requested copies of pertinent documents. During the tour the LPA interviewed ten (10) random residents and two (2) random staff.

Report will continue on LIC9099-C

Unsubstantiated

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: 06/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023

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-20230621094948

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: 06/23/2023

NARRATIVE

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It was alleged that the Facility has an infestation of bed bugs. Based on the interviews conducted it was revealed that the facility did have a bed bug issue in the past but has taken action. Currently there are no reports of bed bugs. Interviews and records reviewed revealed that facility’s past issues with bed bugs have been maintained with the assistance of Bugs ‘N’ Things Pest Control. Administrator stated facility has exterminators come once a month and/or when needed. For any bed bug issues residents would alert facility staff/management and pest control would be scheduled to have each identified room/area with bed bug issue serviced accordingly. The Administrator stated that approximately two weeks ago a resident voiced concerns in room 17 and the exterminators were called. At 1:55 p.m., the LPA observed new mattresses in room 17. Nine (9) out of ten (10) residents interviewed reported no bed bug issues or concerns in their room. Based on interviews and observation, there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that "Facility has an infestation of bed bugs" is deemed UNSUBSTANTIATED at this time.

No deficiencies observed. Exit interview conducted. A copy of the report was issued to Administrator Fe Higgins..

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023

LIC9099 (FAS) - (06/04)

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