565801201-7-19-2021-29-AS-JAPL-C54PK5-20210720112233

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801201
Report Date: 07/19/2021
Date Signed: 07/19/2021 01:58:37 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
09/01/2020 and conducted by Evaluator Kasandra Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20200901152950

FACILITY NAME:	ABSOLUTE CARE HOME		FACILITY NUMBER:	565801201
ADMINISTRATOR:	MARIA LOURDES RICAFORT		FACILITY TYPE:	740
ADDRESS:	1601 KIPLING COURT		TELEPHONE:	(805) 986-8118
CITY:	OXNARD	STATE: CA	ZIP CODE:	93033
CAPACITY:	6	CENSUS: 4	DATE:	07/19/2021
		UNANNOUNCED	TIME BEGAN:	11:18 AM
MET WITH:	Lourdes Ricafort		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Facility staff inappropriately handled resident

INVESTIGATION FINDINGS:

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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 09/10/2020. The LPA met with Administrator Lourdes Ricafort at 11:18 AM and explained the reason for today’s inspection.

The allegation of facility staff inappropriately handled resident alleges during the weeks of 08/16/2020 through 09/01/2020, Resident #1 (R1) had been trying to leave the facility to see their spouse and R1 states the facility staff will not let R1 go and sometimes will hold R1 down to prevent R1 from leaving.
On 09/10/2020, LPA Lopez conducted interviews with administrator Lourdes Ricafort and Staff #1 (S1) at 10:55 AM and conducted a virtual tour. During the tour the LPA observed Resident #1 (R1) to be sleeping.

Report continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (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)

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Control Number 29-AS-20200901152950

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

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During the interview with the administrator Ms. Ricafort, she stated R1 has behaviors of extreme agitation and will want to “go home”. The administrator stated on 08/31/2020, R1 whom is usually calm at night, dashed out the door and ran towards the neighbor’s garage. The administrator stated S1 ran after R1 and guided R1 back to the home. The administrator stated when S1 was guiding R1 back R1 fell in the driveway and had a epilepsy like episode. The administrator was not sure who called but said law enforcement arrived during the incident. The administrator said R1 told the police that they were being tortured and the home was like a prison. The administrator stated R1’s spouse also lives at the facility, but the spouse is declining to see R1 at this time. The administrator stated there was also another incident recently when R1 jumped the fence into the neighbor’s yard. The administrator denied ever holding R1 down to prevent them from leaving and denied ever observing staff hold down R1.

During the interview with S1, they stated R1 wants to leave to “go home” and uses the phone often. S1 stated R1 got agitated recently and ran outside and S1 had to guide R1 back. S1 said when they were guiding R1 back the home, R1 lost their balance and fell and S1 helped R1 up. S1 said when they guide R1 they hold the back of their pants and under the resident’s arm. S1 said around August 13, 2020, R1 jumped the fence into the neighbor’s back yard and S1 had to coax the resident out of the backyard through the gate. S1 stated they have never held R1 on the ground to prevent them from leaving and has never witnessed anyone else do this to the resident.

On 09/10/2020, LPA Lopez reached out to the responding law enforcement officer who stated they responded to a call of someone calling for help. No further information about the incident was obtained.

A subsequent tele-complaint investigation was conducted on 09/14/2020. During this inspection the LPA conducted a face time interview with Resident #1 (R1) at 3:44 PM. During the interview with R1, they stated staff treated them fine and could not recall a time where staff mistreated them or put their hands on R1 and held R1 down.

During today’s inspection the LPA conducted a physical plant tour at 11:20 AM. All four residents were sleeping at the time of the inspection.

Based on the information obtained during the investigation, there is insufficient evidence to support the allegation occurred. Therefore, the allegation is deemed unsubstantiated at this time. The report was reviewed and exit interview conducted with the administrator. A copy the report and appeal rights will be emailed to the administrator.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (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)

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