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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801201
Report Date: 06/21/2024
Date Signed: 06/21/2024 05:29:28 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
05/21/2024 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20240521113502
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: 1DATE:
06/21/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Maria Lourdes Ricafort TIME COMPLETED:
05:35 PM
ALLEGATION(S):
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Staff do not ensure sufficient lighting is provided in resident rooms.
Staff do not ensure adequate personal care supplies are available for residents.
Staff do not ensure residents’ personal care needs are being met in a timely manner.
Staff leave residents soiled for extended periods.
Staff do not ensure facility cleanliness is maintained.
INVESTIGATION FINDINGS:
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At 10:30 a.m. Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced subsequent complaint visit. The LPA met with Administrator Maria Lourdes Ricafort and was explained the reason for the visit.

On 05/21/2024, the LPA toured the facility and interviewed one (1) staff. During today's visit the LPA toured the facility with the administrator, obtained pertinent documents, conducted an interview with a resident's authorized person and conducted staff interviews.

Report will continue on on LIC9099-C (2ND PAGE)

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024
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 4
Control Number 29-AS-20240521113502
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ABSOLUTE CARE HOME
FACILITY NUMBER: 565801201
VISIT DATE: 06/21/2024
NARRATIVE
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On the allegation that Staff do not ensure sufficient lighting is provided in resident rooms; it is the concern of the reporting party that Resident #1’s (R1’s) room was dark and had no overhead light or other lighting in the room available to turn on. To investigate the LPA conducted tours of the facility and Interviews. On 05/21/2024, prior to entering the facility the LPA met with two (2) Oxnard Police Department officers who revealed they had just conducted a visit at the facility and did not have any concerns. On 05/21/2024 the LPA conducted tours of the facility and did not observe overhead light fixture in the bedrooms, however the LPA observed two (2) lamps in R1’s room that provided lighting. In addition R1’s room has a big window that provides natural lighting coming through. Furthermore, interview with the administrator revealed that often residents do not like their rooms too bright and has additional lamps if the residents need additional lighting. The administrator showed the LPA the extra lamp. Although the allegation may have happened or is valid, based on interviews and observations, the above allegation is deemed unsubstantiated at this time.

On the allegation that Staff do not ensure adequate personal care supplies are available for residents; it is the concern of the reporting party that Resident #1’s (R1’s) bed had no sheets on it, the exposed mattress was covered with food crumbs, and staff were not able to provide new sheets or clean pillow covers. It was further reported that the facility did not have an emery board for residents and the nail clippers and disposable razors provided for residents were rusted. To investigate the allegation, interviews and plant tours were conducted. Staff interviews revealed that they, have personal care supplies for the residents including disposable razors, nail clippers, bed sheets and linen. During today’s visit, at approximately 1:10 p.m. the LPA observed one (1) new full box of disposable Gillette razors, one (1) opened box with new disposable Gillette razors, and one (1) opened package of Blade for men with new disposable razors. The LPA also observed two nail clippers, of which one was rusted in the inside of handles and the other was not rusted. The LPA did not observe rust on any of the nail clippers blades. At 1:15 p.m. the LPA observed R1’s bed covered with a comforter and no bedsheet. Upon observation, the administrator stated that due to R1 using a special low-air loss mattress they do not use fitted sheets since they easily come undone when the resident moves and use a comforter instead since it is heavier and the resident sleeps over the comforter and not directly on top of the mattress. The administrator also stated that they can provide bedsheets if the resident wants them. Interviews with R1 revealed that they do not have concerns with their bed. The LPA observed a closet full of sheets and bed linen. The LPA did not observe any soiled pillows. Although the allegation may have happened or is valid, based on interviews and observations, the above allegation is deemed unsubstantiated at this time. Report will continue on LIC9099-C (3RD PAGE).
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20240521113502
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ABSOLUTE CARE HOME
FACILITY NUMBER: 565801201
VISIT DATE: 06/21/2024
NARRATIVE
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On the allegation that Staff do not ensure residents’ personal care needs are being met in a timely manner and Staff leave residents soiled for extended periods; it is the concern of the reporting party that Resident #1’s (R1’s) fingernails were dirty and looked like they had not been cut or cleaned in months, R1 was observed to have soiled brief that was so soaked and starting to disintegrate, and R1’s face was observed to be dirty with old, crusted food on it and long facial hair. It was further reported that Resident #2 was in a similar state as R1 with long facial hair, dirty uncut nails and that R2 was observed with a disposable chux and diaper that was saturated with urine and falling apart. To investigate the allegations the LPA conducted plant tours and interviews. Staff interviews revealed that Hospice provides grooming services to the residents, that includes showers, shaving, and cutting their fingernails, however that if the residents need those services staff will provide them. Furthermore, staff interviews revealed that they check and change the residents diapers every two hours or when needed and do not leave them soiled. On 05/21/2024, prior to entering the facility the LPA met with two (2) Oxnard Police Department officers who revealed they had just conducted a visit at the facility, interviewed the residents and did not have any concerns regarding the allegations. One of the officers stated that the facility and residents seemed clean. On 05/21/24, the LPA was not able to interview R1 and R2 as R1 was sleeping and R2 declined to be interviewed and did not allow the LPA to enter their room. During today’s visit the LPA was able to interview R1, who indicated that they do not have any concerns and are happy at the facility. R1 does not remember when their nails and beard was last cut. The LPA did not observe any dirt under R1’s nails, did not observe nails to be long, and did not observe face to be dirty. The LPA observed R1 clean. Throughout today’s visit the LPA observed staff constantly checking on R1 and assisting them with their incontinent needs. R2 is no longer at the facility. Lastly, interviews with R1’s authorized person revealed that they visit R1 every three (3) to four (4) weeks and always observes R1 clean with their nails clipped, hair cleaned, no bed sores, and R1’s bed with covers. R1’s authorized person has no concerns regarding the care that is being provided by facility staff. Although the allegation may have happened or is valid, based on interviews and observations, the above allegation is deemed unsubstantiated at this time.

Report will continue on LIC9099-C (4TH PAGE).
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 29-AS-20240521113502
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ABSOLUTE CARE HOME
FACILITY NUMBER: 565801201
VISIT DATE: 06/21/2024
NARRATIVE
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On the allegation that Staff do not ensure facility cleanliness is maintained; it is the concern of the reporting party that the facility was observed to be cluttered with various items that were dusty, the furniture was dirty and dusty, and the kitchen and dining table were full of dirty dishes and old food. To investigate the allegation the LPA conducted interviews and plant tours. On 05/21/2024, prior to entering the facility the LPA met with two (2) Oxnard Police Department officers who revealed they had just conducted a visit at the facility, interviewed the residents and did not have any concerns regarding the allegations. One of the officers stated that the facility and residents seemed clean. On both visits conducted by the LPA, the facility appeared clean. The LPA did not observed dirty dishes or old food in the dinning table or in the sink. The LPA did not observe the furniture dirty or dusty. Furthermore, during today’s visit, the LPA observed a mop in a vacant room, and a bottle of vinegar in the restroom. Administrator stated that they were spring cleaning prior to the LPA’s visit. Although the allegation may have happened or is valid, based on interviews and observations, the above allegation is deemed unsubstantiated at this time.

Exit interview conducted. A copy of the report was issued.
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4