561703573-7-1-2024-29-AS-KHEN-D7FVSR-20240723164158

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 561703573
Report Date: 07/01/2024
Date Signed: 07/01/2024 03:23:56 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/24/2024 and conducted by Evaluator Kelly Dulek

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20240624084221

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:	07/01/2024
		UNANNOUNCED	TIME BEGAN:	11:08 AM
MET WITH:	Fe Higgins & Irina Zendejas		TIME COMPLETED:	03:25 PM

ALLEGATION(S):

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Facility does not have hot water
Staff did not ensure there was enough food for residents in care
Staff make residents clean the facility
Staff are not properly cleaning residents' rooms

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek conducted a complaint visit to this facility for the above listed allegations. LPA met with facility staff Irina Zendejas and Licensee/Administrator Fe Higgins. Entrance interview conducted.

LPA interviewed both Licensee/Administrator and facility staff at 11:15AM, toured the facility with Licensee at 11:55AM. LPA observed lunch being served and residents eating in the dining room during facility tour. LPA interviewed facility residents and staff from 12:15PM to 02:20PM. The following was then determined:

Allegation: "Facility does not have hot water:"
Interview revealed that on 06/21/2024, residents informed the facility staff that there was no hot water available in their restrooms. Facility staff then tested the water and confirmed the water was tepid and not heating properly. Maintenance staff responded promptly and discovered that the water heater/broiler was Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024

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-20240624084221

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ELMS RESIDENTIAL CARE	FACILITY NUMBER: 561703573
	VISIT DATE: 07/01/2024

NARRATIVE

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broken and needed to be replaced. Interview revealed that facility staff informed the residents of the needed repairs and instructed residents to inform the staff if they needed hot water. Facility staff were able to use the stove top to heat water as needed for resident use as well as to cook. Interview revealed that a new water heater was installed immediately and within a 24-hour period, service was restored to all resident rooms. LPA confirmed during today's visit that the hot water temperature is within the required range. Based on interview and observation, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that "facility does not have hot water" is deemed UNSUBSTANTIATED at this time.

Allegation: "Staff did not ensure there was enough food for residents in care:"

During today's visit, LPA observed lunch being served and residents eating in the dining room. Residents were observed with sufficient food from a variety of food groups served today. Interview revealed that while the facility could vary the food selection more, there is always a sufficient quantity of food served. There are 3 (three) meals and 2 (two) snacks served daily. LPA observed the facility pantry as well as multiple refrigerators and freezers. LPA took photographs of the food observed at the facility during today's visit. LPA observed a sufficient quantity of both perishable and non-perishable foods in all food groups during today's visit. Based on interview and observation, there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation "staff did not ensure there was enough food for residents in care" is deemed UNSUBSTANTIATED at this time.

Allegations: "Staff make residents clean the facility" and "Staff are not properly cleaning residents' rooms:"

The complaint alleges that there is insufficient staffing at the facility, which has resulted in staff not cleaning the resident rooms properly and staff forcing residents to do chores and clean the facility. LPA observed the facility staff schedule, which indicated staff assigned to cleaning duties. LPA observed staff cleaning and doing resident laundry during today's visit. Interviews revealed that one resident chooses to collect trash from resident rooms. The resident then sorts out the recycling items from the trash and takes the cans and plastics to the recycling center. This resident reports keeping the money for all items taken to the recycling center. This resident indicated to the LPA that no staff asked them to take the trash, nor are they forced to
Report Continued on LIC 9099-C

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20240624084221

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ELMS RESIDENTIAL CARE	FACILITY NUMBER: 561703573
	VISIT DATE: 07/01/2024

NARRATIVE

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clean or take trash. Instead, they chose to take the trash out voluntarily and this resident enjoys receiving the money from the recycling center by completing this task. Interviews also reveled that there are staff specifically designated for cleaning resident rooms and restrooms, as well as facility common areas. Most rooms are cleaned daily, unless the resident refuses. Interviews revealed that there are residents who refuse room cleaning. When a resident refuses, the staff will return later to try again or will choose another strategy to ensure proper cleaning of the resident room. They will offer to allow the resident to remain in their room when the staff clean or they will go in the resident room quickly while the resident is out at a meal to quickly sweep and mop the floor. Restrooms are jack-and-jill style, so typically staff are able to clean the restroom when needed by entering from either connected room. Based on interview and observation, there is insufficient evidence to support the allegation or that a violation occurred, therefore the allegations "staff make residents clean the facility" and "staff are not properly cleaning residents' rooms" are deemed UNSUBSTANTIATED at this time.

No citations issued. Exit interview conducted. A copy of today's report was provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024

LIC9099 (FAS) - (06/04)

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