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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801201
Report Date: 03/19/2024
Date Signed: 03/19/2024 03:45:36 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
03/18/2024 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20240318082439
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
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Maria Lourdes RicafortTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Staff does not ensure facility is clean and sanitized.
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INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced initial complaint visit for the above allegations. The LPA arrived at 12:30 PM, met with Administrator Maria Lourdes Ricafort, and explained the reason for today's visit.

During today’s visit, the LPA along with the Administrator toured the facility, interviewed two (2) residents, and one (1) staff between 12:35 p.m and 3:40 p.m . The LPA also obtained pertinent documents.

Report will continue on LIC9099-C.


Unsubstantiated
Estimated Days of Completion:
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.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 29-AS-20240318082439
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
VISIT DATE: 03/19/2024
NARRATIVE
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Regarding the allegation: Staff does not ensure facility is clean and sanitized; it is the reporting party’s concern that the kitchen sink was full of dirty dishes and food out on counters. It was further reported that the dining room table had papers and boxes stacked, plastic containers stored inside oven and pots on top of stove. To investigate the complaint the LPA conducted a tour of the kitchen. During today’s visit the LPA did not observed dirty dishes inside the sink and the dining table had fruit and snacks available for the residents. In addition, during today’s visit, the LPA observed a caregiver washing dishes and observed pot of food on the stove that was cooking. Based on the LPA’s observations, the Department does not have sufficient evidence to support the above allegation. Therefore, this allegation is deemed Unsubstantiated at this time.

Exit interview conducted. Today's report was reviewed and 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
LIC9099 (FAS) - (06/04)
Page: 3 of 3