<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801201
Report Date: 07/19/2021
Date Signed: 07/19/2021 01:50:27 PM



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
12/21/2020 and conducted by Evaluator Kasandra Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20201221164003
FACILITY NAME:ABSOLUTE CARE HOMEFACILITY NUMBER:
565801201
ADMINISTRATOR:MARIA LOURDES RICAFORTFACILITY TYPE:
740
ADDRESS:1601 KIPLING COURTTELEPHONE:
(805) 986-8118
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:6CENSUS: 4DATE:
07/19/2021
UNANNOUNCEDTIME BEGAN:
11:18 AM
MET WITH:Lourdes RicafortTIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is cluttered.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced subsequent complaint inspection at the facility today. The purpose of the visit is to conclude an investigation initiated by LPA on 12/30/2020. The LPA met with Administrator Lourdes Ricafort at 11:18 AM and explained the reason for today’s inspection.

The allegation of facility is cluttered alleges on 12/16/2020, a credible witness observed the facility to be cluttered with boxes, papers, and stuff all over the floors. The kitchen table was also completely covered with papers and other miscellaneous items and there was not a chair to sit on. When the credible witness asked the administrator Lourdes Ricafort where the residents eat, the administrator responded the residents eat in their bedrooms. During a tour of the facility, the administrator had to move boxes out of the way for the credible witness. The credible witness said the facility did not appear to be dirty just extremely cluttered.

Report continued on LIC 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021
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-20201221164003
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: ABSOLUTE CARE HOME
FACILITY NUMBER: 565801201
VISIT DATE: 07/19/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
On 12/30/2020, the LPA conducted an unannounced virtual inspection of the facility with administrator Lourdes Ricafort beginning at 10:57 AM. The LPA observed the kitchen, kitchen table, common areas and resident rooms to be clean and free of clutter. During the inspection the LPA conducted an interview with the administrator and she confirmed that the home was cluttered in the kitchen and living room area only when the credible witness arrived but stated this was due to Christmas and receiving packages. Also the time of day when the individual arrived, it was a busy time of the day, breakfast had just been served and the facility was being cleaned and staff were preparing for lunch. The administrator stated fresh food had also just been delivered to the facility and the facility prepares all meals from scratch and does not used canned food. The administrator also stated all the residents are receiving meals in their bedrooms due to COVID-19 protocols.

During today's inspection, the LPA conducted a physical plant tour at 11:20 AM and observed the home to be clean and free of clutter.

Based on the information obtained, a credible witness observed the facility to be cluttered on 12/16/2020 and the administrator confirmed this. Therefore, the allegation is deemed substantiated.

The report was reviewed and exit interview conducted with the administrator Lourdes Ricafort. A copy of the report and appeal rights will be emailed.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20201221164003
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: ABSOLUTE CARE HOME
FACILITY NUMBER: 565801201
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/19/2021
Section Cited
CCR
87303(a)
1
2
3
4
5
6
7
87303 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 and well-being of residents, employees and visitors. This requirement is not met as evidenced by:
1
2
3
4
5
6
7
The LPA observed the facility to be clean and free of clutter today. Plan of correction is cleared.
8
9
10
11
12
13
14
Based on interview, the licensee did not comply with the section cited above as the facility was observed to be cluttered on 12/16/20 by a credible witness which poses a potential safety risk to residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3