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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801201
Report Date: 06/21/2024
Date Signed: 06/21/2024 05:21:48 PM


Document Has Been Signed on 06/21/2024 05:21 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: 1DATE:
06/21/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Maria Lourdes Ricafort TIME COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analysts (LPA) Esther Cortez conducted an unannounced Case Management -Deficiencies visit in conjunction with a subsequent 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.

Upon arrival, on 03/19/2024 it was revealed that the administrator's family member, individual #1 (I1) was living at the facility, due to medical reasons. However, it was unclear during that visit if I1 was a resident of the facility. On 05/21/2024, it was revealed that I1 was not a resident of the facility, however they were still living at the facility. On 05/21/2024 per record review, conducted by the LPA on the Guardian Background Check System website and Licensing Information System, the LPA did not observe I1 to have a fingerprint clearance and be associated to the facility. Interviews with the Administrator revealed that I1 obtained a fingerprint clearance and was associated to the facility after the LPA's visit on 05/21/2024.

Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8, the following deficiency was cited (refer to LIC 809-D). Civil Penalty assessed in the amount of $500. Failure to correct the deficiencies may result in additional civil penalties.


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: 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.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/21/2024 05:21 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: 06/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/22/2024
Section Cited
CCR
87355(e)(1)

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87355(e)(1)Criminal Record Clearance (e) All individuals subject to a criminal record review...(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance... This requirement is not met as evidenced by:
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POC has been met, I1 has obtained a criminal reord clearance and associated to the facility.

Civil Penalties assessed in the amount of $500.
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Based on record review and interviews the licensee did not comply with the section cited above by not ensuring that I1 has a criminal record clearance and associated to the facility which poses an immediate health, safety and personal rights 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: 06/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2024
LIC809 (FAS) - (06/04)
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