561703573-7-31-2024-29-AS-DPEA-D7Q5LZ-20240731200359

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 561703573
Report Date: 07/30/2024
Date Signed: 07/31/2024 05:24:51 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
03/14/2024 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20240314113625

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:	07/30/2024
		UNANNOUNCED	TIME BEGAN:	03:45 PM
MET WITH:	Irina Zendejas, Administrator Assistant		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff did not provide adequate care and supervision of the residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit to deliver investigation finding. Upon arrival LPA met with Irina Zendeja. The reason for the visit was explained.

On 03/14/2024, Community Care Licensing Division received an allegation of “Staff did not provide adequate care and supervision of the residents”. It was reported that someone summonsed emergency personnel due to a resident observed unable to be woken and yellowish in color. Upon arrival of emergency personnel, the alleged resident was found sleeping deeply and was easily woken. It was reported that on this incident day no staff/employees could be found inside the facility; no historian of the alleged resident was available, and no one could be identified as the 911 caller. It was stated that the population of this facility is vulnerable at best and it appears many if not all of the residents have cognitive impairments of some kind and should not be left alone.

On 03/20/2024, LPA Chochian conducted the initial complaint visit. (Continue to Lic9099c).

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

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-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
	VISIT DATE: 07/30/2024

NARRATIVE

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During the initial visit, at approximately 12pm LPA toured the facility with staff. During the tour random residents were interviewed between 12pm-1pm. At approximately 1pm, LPA conducted interview with staff. In addition, facility staff schedule was observed which showed that facility is staffed with at least 2-3 staff during the AM/PM shift and 1 staff on the graveyard shift.

According to reporting party the residents at this facility are not provided appropriate care and supervision due to insufficient staffing. Staff Irina Zendejas who manages residents’ medication and also assists the administrator, stated that she and at least two other staff are on duty during the AM/PM shift and have at least one staff for the graveyard shift. Staff interviewed confirmed that they were present and observed emergency personnel in the facility attending to the resident who was unable to be woken up by roommate and staff. It was also reported the emergency personnel were eventually able to locate staff prior to leaving facility.

Based on the above information gathered although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegation “Staff did not provide adequate care and supervision of the residents” is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. Appeal rights and a copy of the report was provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

LIC9099 (FAS) - (06/04)

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