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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 561703573
Report Date: 03/20/2024
Date Signed: 03/21/2024 09:22:08 AM

Substantiated


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
03/14/2024 and conducted by Evaluator Zabel Chochian
COMPLAINT CONTROL NUMBER: 29-AS-20240314113625
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:
03/20/2024
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Irina ZendejasTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Facility electrical panel is malfunctioning
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Zabel Chochian conducted a complaint visit to this facility for the above complaint allegation. LPA met with staff Irina Zendejas and reason for visit was discussed. Owner/Administrator Fe Higgins was unavailable to met with LPA during todays visit.

LPA toured the facility with Maintenance staff Ariel Vargs. Mr. Vargas confirmed that the facility electrical panel was malfunctioning last week and he has since taken care of the issue which was causing the alarm panel to sound. According to Mr. Vargs the fire department suggested that the fire panel spare battery be replaced since it is malfunctioning. Mr. Vargas replaced the spare battery and the panel is operating properly now.

Based on interviews and observation, allegation "Facility electrical panel is malfunctiong" is deemed substantiated at this time. Following deficiency was observed (See LIC 9099-D.) and cited from the CA Code of Regulations, Title 22. Exit interview conducted. Copy of report and appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel ChochianTELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
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 3
Control Number 29-AS-20240314113625
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/20/2024
Section Cited
CCR
87303(a)
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Maintenance and Operation: (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety.....
This requirement is not met as evidence by:
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Maintenance staff replaced the broken valve last week. Staff stated that all necessary repairs are made to ensure the electrical fire panel functions properly. LPA observed a new battery installed in the fire panel today.
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Based on observation and interview with staff it was confirmed that the facility fire panel was malfunctioning due to issue with an broken valve and low battery, which poses a potiential health and safety risk to clients in care.
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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: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel ChochianTELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3