561703573-9-13-2023-29-AS-KLOZ-CX523X-20231030170304

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 561703573
Report Date: 09/13/2023
Date Signed: 09/13/2023 03:55:27 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
09/07/2023 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20230907164110

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:	04:00 PM

ALLEGATION(S):

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Staff mismanaged residents' medications.

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.

Report will Continue on LIC9099-C

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)

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Control Number 29-AS-20230907164110

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 staff mismanaged residents' medications, it was further reported that residents were not receiving their medications and that a resident had to pick up their own medication from the facility as the facility was not providing pickup services for medication refills at this time. 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. Two out of five residents interviewed revealed that they have missed medications on one occasion due to the facility not being able to provide them, however they did not go to the pharmacy to pick up their own medications. Based on interviews, the preponderance of evidence standard has been met, therefore the above allegation is deemed Substantiated at this time.

Although the allegation was Substantiated, staff mismanaged residents' medications was cited on a separate report from complaint # 29-AS-20230913095109 conducted on 09/13/2023.

Exit interview conducted. A copy of the report was 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)

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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
09/07/2023 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20230907164110

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:	04:00 PM

ALLEGATION(S):

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Facility is in disrepair.

INVESTIGATION FINDINGS:

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This report is being amended to remove "Elms Residential Care residents" from the allegation.
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 ‘Facility is in disrepair alleges that the toilets were not working due to a backup, and that there are bed bugs. All residents interviewed confirmed that their restroom is working and were not aware of any issues with the toilets. Resident interviews also revealed that if there were any issues, they can voice concerns with staff and get them resolved. Administrator Fe indicated that there had been a bed bug sighting, however an exterminator had been called to service the facility on 09/09/2023. An invoice of the bed bug service was provided to the LPA. Based on interviews 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)

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