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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801201
Report Date: 09/21/2021
Date Signed: 09/21/2021 05:43:49 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
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: 3DATE:
09/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:33 AM
MET WITH:Lourdes RicafortTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced Required - 1 Year inspection at the facility today. At 10:33 AM the LPA met with Administrator Lourdes Ricafort and explained the reason for the inspection. Today's annual has an emphasis on infection control practices and procedures.

The LPA, along with Administrator, toured the physical plant areas inside and outside beginning at 10:40 AM to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations.

COMMON SPACES: The common areas were observed. The fire extinguishers were observed to be last serviced on 07/23/2021. The smoke alarms and carbon monoxide detectors were tested in the common areas and resident bedrooms at 10:52 AM and they were all operational. The facility has a sufficient supply of perishable and non-perishable food. There is outdoor seating by the front door and side yard for resident visitation use. Cleaning supplies are secured in the locked garage.

BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.

RESTROOMS: There are two resident bathrooms. The hallway bathroom water temperature measured at 111.2 degrees F at 10:48 AM. Bathrooms had hand soap, paper towels, and signs regarding proper hand washing.

INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. There is 1 entry into the facility. Upon entry, the facility has a central entry point for symptom screening. The LPA observed an adequate supply of Personal Protective Equipment (PPE). The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19.

No deficiencies were observed at this time. Exit interview conducted. A copy of the report will be emailed.

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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