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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801201
Report Date: 03/19/2024
Date Signed: 03/19/2024 03:41:38 PM


Document Has Been Signed on 03/19/2024 03:41 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 HOMEFACILITY NUMBER:
565801201
ADMINISTRATOR:MARIA LOURDES RICAFORTFACILITY TYPE:
740
ADDRESS:1601 KIPLING COURTTELEPHONE:
(805) 986-8118
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:6CENSUS: 3DATE:
03/19/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Maria Lourdes RicafortTIME COMPLETED:
03:50 PM
NARRATIVE
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Licensing Program Analysts (LPA) Esther Cortez conducted an unannounced Case Management -Deficiencies visit in conjunction with a 10-day complaint visit (Complaint Control #29-AS-20240318082439). The purpose of the visit is to issue citations for deficiency observed during the complaint investigation which is not related to the complaint. LPA met with administrator Maria Lourdes Ricafort and the reason for the visit was explained.

At 2:04 p.m. the LPA observed three small containers with medication pills inside in a resident's room (R1), accessible to all residents in care. R1's room had the door open and unlocked. Upon observation the administrator remove the medication and store it inaccessible to the residents in care. This facility serves residents who cannot manage medication due to their diagnosis of dementia, including R1.

Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8, the following deficiencies were cited (refer to LIC 809-D).

Exit interview conducted, today's reports and appeal rights were provided to the Administrator.
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:
DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/19/2024
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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Document Has Been Signed on 03/19/2024 03:41 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/19/2024
Section Cited
CCR
87705(f)(2)

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87705(f)(2)Care of Persons with Dementia
(f)...inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances... This requirement is not met as evidenced by:
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Medication in R1's room was secured during today's visit. Plan of Correction met.

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Based on observation, the licensee did not comply with the section above as medication was accessible in R1's room, which poses an immediate health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:
DATE: 03/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/19/2024
LIC809 (FAS) - (06/04)
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