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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561703573
Report Date: 06/12/2024
Date Signed: 06/12/2024 03:38:21 PM


Document Has Been Signed on 06/12/2024 03:38 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:ELMS RESIDENTIAL CAREFACILITY NUMBER:
561703573
ADMINISTRATOR:HIGGINS, FE LILIA 98FACILITY TYPE:
740
ADDRESS:67 EAST BARNETTTELEPHONE:
(805) 643-2176
CITY:VENTURASTATE: CAZIP CODE:
93001
CAPACITY:54CENSUS: 43DATE:
06/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:09 AM
MET WITH:Fe HigginsTIME COMPLETED:
03:40 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Angela Barutyan, Trevor Byrne, and Kelly Dulek, along with Licensing Program Managers (LPMs) KaSandra Lopez and Kristin Heffernan conducted a Case Management visit at the facility today. The purpose of the visit was to discuss the future plans for the facility due to the pending sale of the property. LPAs and LPMs met with Administrator/Licensee Fe Higgins and explained the reason for today's visit. Entrance interview conducted.

During today's visit, LPAs and LPMs interviewed Fe Higgins at 11:15AM, reviewed resident files, and participated in a telephone call with other relevant parties.

Exit interview conducted. A copy of today's report was provided.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly DulekTELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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