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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801201
Report Date: 11/23/2021
Date Signed: 11/23/2021 03:59:28 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 HOMEFACILITY NUMBER:
565801201
ADMINISTRATOR:MARIA LOURDES RICAFORTFACILITY TYPE:
740
ADDRESS:1601 KIPLING COURTTELEPHONE:
(805) 986-8118
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:6CENSUS: 3DATE:
11/23/2021
UNANNOUNCEDTIME BEGAN:
12:28 PM
MET WITH:Lourdes RicafortTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Residents not being provided adequate food services.
Staff not providing services in a timely matter.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced initial complaint inspection at the facility regarding the above allegations. The LPA met with Administrator Lourdes Ricafort at 12:28 PM and explained the reason for today's inspection.

During today's inspection, the LPA conducted a physical plant tour of the home beginning at 12:35 PM. Between 12:35 PM and 2:30 PM, the LPA conducted interviews with the Administrator Lourdes Ricafort, Resident #1 (R1), Witness #1 (W1), Witness #2 (W2), Staff #1 (S1) and Staff #2 (S2). The LPA reviewed facility records at 2:39 PM. The LPA met briefly with Resident #2 (R2) when they were eating lunch. Resident #3 (R3) was sleeping during the time of the inspection.

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

DATE: 11/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2021
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-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: 11/23/2021
NARRATIVE
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During the today's inspection, the LPA observed chicken, rice, potatoes, and vegetables being prepared for lunch. During the interview with R1, R1 stated they are served a variety of foods, including different types of meats or fish and were happy with the food being served. R1 stated for breakfast today, R1 had oatmeal and fruit. Interviews with W1 and W2 revealed no concerns regarding the meals being served to R1. W1 also drafted a letter of support for the facility. The interview with the Administrator revealed R1 is always served proteins, and a variety of fresh fruits and vegetables. The allegation of 'Residents not being provided adequate food services' alleges, R1 is only served rice and vegetables for all meals. Based on the information obtained during the investigation, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of 'Residents not being provided adequate food services' is deemed unsubstantiated at this time.

The allegation of 'Staff not providing services in a timely matter' alleges R1 soils them self often because there is always someone in the one restroom. During the physical plant tour, it was observed there were two restrooms in the home, a common restroom in the hallway and an on suite restroom in a vacant bedroom. Interviews with R1 revealed they are able to use the restroom unassisted, and it if the hallway restroom is occupied they are able to use the other restroom down the hallway. R1 denied soiling them self due to a restroom not being available. Staff interviews revealed R1 is sometimes incontinent but has never soiled them self due to a restroom not being available. Based on the information obtained during the investigation, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of 'Staff not providing services in a timely matter' is deemed unsubstantiated at this time.

Exit interview and report reviewed with the Administrator. A copy of the report and appeal rights was emailed.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 11/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3