565801201-1-7-2022-29-AS-DPEA-CDHLZR-20220415091223

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801201
Report Date: 01/07/2022
Date Signed: 01/07/2022 02:45:23 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
11/19/2021 and conducted by Evaluator Kasandra Lopez

COMPLAINT CONTROL NUMBER: 29-AS-20211119120840

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: 3	DATE:	01/07/2022
		UNANNOUNCED	TIME BEGAN:	10:36 AM
MET WITH:	Lourdes Ricafort		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Residents are not being supervised adequately
Facility not cleaned and free of insects

INVESTIGATION FINDINGS:

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Licensing Progam Analyst (LPA) KaSandra Lopez conducted an unannounced subsequent complaint inspection regarding the above allegations. The LPA met with Administrator Lourdes Ricafort and explained the reason for the inspection.

During today's inspection, the LPA conducted a physical plant tour of the facility at 10:41 AM. The LPA observed three residents in their bedrooms and Staff #1 (S1) present, in addition to the Administrator. The allegation of 'Residents are not being supervised adequately' alleged on or around, 11/19/2021, a resident answered the door and residents were left unsupervised with no staff present.

During the previous inspection on 11/23/2021, the LPA conducted a physical plant tour and observed Staff #1 (S1) and the Administrator present. During the 11/23/2021 inspection, the LPA conducted interviews with the Administrator, Resident #1 (R1), Witness #1 (W1), Witness #2 (W2), Staff #1 (S1) and Staff #2 (S2). 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: 01/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2022

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-20211119120840

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: 01/07/2022

NARRATIVE

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The interview with S1 revealed when the reporting party arrived at the facility, S1 was present on facility grounds but was in the backyard at the time, cleaning soiled resident clothing. S2 who is a live in family member of the Administrator, and not considered a staff member or resident, answered the door when the reporting party arrived. During the interview with S2, S2 denied being left alone with the residents. Interviews with R1, W1 and W2 also revealed the Administrator or S1 is always present. Based on the LPA's observation and interviews conducted, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of 'Residents are not being supervised adequately' is deemed unsubstantiated at this time.

The allegation of 'Facility not cleaned and free of insects' alleges dirty rags are left on the floor and flies and bugs are present in the home. During the 11/23/2021 inspection and during today's inspection, the LPA did not observe the presence of bugs or flies in the home. During the 11/23/2021 inspection, the LPA did observe a towel on the floor in the restroom but the Administrator stated that was due to a resident recently taking a shower and removed the towel from the floor. Based on the information obtained, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of 'Facility not cleaned and free of insects' is deemed unsubstantiated at this time.

Exit interview and report reviewed with the Administrator. A copy of the report and appeal rights were emailed.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2022

LIC9099 (FAS) - (06/04)

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