561703573-9-13-2023-29-AS-KLOZ-CW5V57-20230929160728

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 561703573
Report Date: 09/13/2023
Date Signed: 09/13/2023 03:47:23 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
09/13/2023 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20230913095109

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: 43	DATE:	09/13/2023
		UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Fe Higgins		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Residents are not receiving their medications

INVESTIGATION FINDINGS:

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Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 4

Control Number 29-AS-20230913095109

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ELMS RESIDENTIAL CARE	FACILITY NUMBER: 561703573
	VISIT DATE: 09/13/2023

NARRATIVE

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Regarding the allegation that Residents are not receiving their medications, it was further reported that it was unknown who was passing out resident medications and if the residents had access to their medications. Administrator Fe Higgins stated that the staff who are primarily responsible for medications are currently not working, causing a setback in medication pick up from the pharmacy. It was also stated that she and other staff have taken charge of medications and are currently arranging medication delivery and pick-ups with the pharmacy. Administrator Fe further stated that due to the current changes, one resident was not able to receive their PRN medication on 9/12/23 as the facility was not able to pick up the medication and was going to be scheduling pick-up date today with the pharmacy. The LPA interviewed five randomly selected residents during the visit. All resident interviews confirmed that they have access to their medications and administrator Fe currently passes out medications. However, two out of five residents interviewed revealed that even though the facility does provide their medication they have missed medications on one occasion due to the facility not being able to provide them. Based on interviews, the preponderance of evidence standard has been met, therefore the above allegation is deemed Substantiated at this time.

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: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
09/13/2023 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20230913095109

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: 43	DATE:	09/13/2023
		UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Fe Higgins		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Insufficient staffing to meet residents care needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Esther Cortez conducted a 10-Day initial complaint visit to the facility at 10:50 a.m. The LPA was greeted by Administrator Fe Higgins and the reason for the visit was explained.
The LPA toured the physical plant with administrator Fe, and obtained pertinent documents at 11:35 a.m., and interviewed five (5) randomly chosen residents between 11:40 a.m. and 12:20 p.m. and interviewed the administrator throughout the visit.

The allegation of ‘Insufficient staffing to meet residents care needs alleges that Administrator Fe is the only staff working and cooking at the facility. During the inspection, the LPA observed administrator Fe and three other staff assisting residents. All residents interviewed stated there is sufficient staffing to meet their needs. They also indicated that they are independent and don’t need assistance from staff other than laundry, medication and meal services which are provided. Based on interviews and observations the allegation above is deemed unsubstantiated at this time. Exit interview conducted. A copy of the report was provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20230913095109

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ELMS RESIDENTIAL CARE	FACILITY NUMBER: 561703573
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/13/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/15/2023 Section Cited CCR 87465(a)(4)	1 2 3 4 5 6 7	87465 Incidental Medical and Dental Care (a) (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Administrator shall submit proof of receipt of R1's medication by 9/15/23.
	8 9 10 11 12 13 14	Based on interview, the licensee failed to comply with the section cited above as R1 did not receive their medication on 9/12/23 due it not being ordered timely which poses an immediate health risk to R1 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: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4