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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 567609799
Report Date: 11/17/2023
Date Signed: 11/17/2023 04:12:01 PM

Document Has Been Signed on 11/17/2023 04:12 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:CONNIE'S RESIDENTIAL CARE HOMEFACILITY NUMBER:
567609799
ADMINISTRATOR:FLORO CORTESFACILITY TYPE:
735
ADDRESS:614 E NECTARINE STTELEPHONE:
(805) 240-2188
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY: 6CENSUS: 5DATE:
11/17/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Floro Cortes, Jr.TIME COMPLETED:
04:30 PM
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An Informal Conference was conducted today in the Woodland Hills Adult and Senior Care Regional Office. The purpose of this Informal Conference is to discuss deficiencies cited during the period of 2020-2023 as well as concerns arising from these identified deficiencies.

Present at today's meeting are the following:


Floro Cortes, Jr., Licensee/Administrator
Freddie Garcia, Tri-Counties Regional Center Quality Assurance Manager (via video conference)
Katy Robison, Tri-Counties Regional Center Quality Assurance Specialist (via video conference)
Desaree Perera, Licensing Program Manager (LPM)
Kristin Heffernan, Licensing Program Manager (LPM)
KaSandra Lopez, Licensing Program Manager (LPM)
Teresa Camara, Licensing Program Analyst (LPA)

The informal conference process was explained to the Licensee. The Licensee was also informed that this Informal Conference is a part of the administrative action process. Further citations may result in a Non-Compliance Conference, which could include various administrative actions.

Brief History: The licensee owns three adult residential facilities:

1. Cortes Adult Family Home (565801321) which was first licensed on 10/12/2005 for a capacity of 6 clients.

2. Connie’s Residential Care Home (567609799) which was first licensed on 5/28/2019 for a capacity of 6 clients.

3. The Cottonwood (561702356) which was first licensed on 1/9/1993 for a capacity of 24 clients.

(continued on 809-C; page 2)

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: CONNIE'S RESIDENTIAL CARE HOME
FACILITY NUMBER: 567609799
VISIT DATE: 11/17/2023
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The parties discussed deficiencies related to the following incidents and observations:

Cortes Adult Family Home (census 5):

On 8/22/2023, the licensee was cited for lack of supervision and failure to protect a client from inappropriate sexual touching by another client. On 10/9/2023, there was another inappropriate client on client contact. During these incidents the census was 5 and there was only one staff at the facility. The licensee has hired another staff, but that staff gives the live-in staff a break; there is still only one staff present at the facility.

On 8/4/2023 the licensee was cited for not seeking timely medical treatment for a client who experienced seizures on multiple occasions and the licensee failed to report these incidents. During these incidents there was only one staff at the facility.

On 10/26/2023, the licensee was cited for not having evidence of medication training. The licensee has provided training to staff at the facility.

The licensee stated he is considering hiring another administrator for this facility. He has met with the Tri-Counties Regional Center planning team for two of the clients at this facility who need additional supervision and/or additional counseling.

Connie’s Residential Care Home (census 5):

On 4/21/2023, the licensee was cited for not having a certified administrator, ensuring they had updated medical assessments for clients, using common towels for hand washing, and not providing a shaded outdoor area.

The licensee stated he feels some of the clients at this facility need a higher level of care and may speak with the Tri-Counties Regional Center planning team to increase the level of the home from a level two to level three. In addition, the licensee is intending to hire another administrator for this facility. He stated he will be contacting a former administrator who had taken a leave of absence for health reasons but it is his understanding she may be available part-time.

(continued on 809-C; page 3)

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: CONNIE'S RESIDENTIAL CARE HOME
FACILITY NUMBER: 567609799
VISIT DATE: 11/17/2023
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(continued 809-C; page 2)

The Cottonwood (census 24):

The licensee has been cited multiple times (9/25/2023, 5/31/2023, 11/10/2022, 2/24/2022, 1/19/2022, 9/10/2021, 2/1/2020) for issues with buildings and grounds, including but not limited to rodents, flooring and walls in disrepair, not safeguarding personal property from rodent damage, unpermitted structures, and heaters not working.

On 11/10/2022, the licensee was cited for not having a plan to handle client behaviors.

On 1/19/2022, the licensee was cited for not providing snacks and fresh fruit as well as not providing activities.

The licensee stated he is working with Ventura County Behavioral Health to obtain a grant from the State of California for improvements to the property and funding for additional staffing hours. The licensee stated he is considering hiring another administrator for this facility.

The licensee, Floro Cortes, Jr., is listed as the administrator of all three facilities noted above. The parties discussed how much time Mr. Cortes spends at each of these facilities. Mr. Cortes stated he understands he must hire another administrator for at least one of his facilities by 12/22/2023. In addition, the licensee will provide Community Care Licensing (CCL) updated staff schedules (LIC 500) by 11/20/2023.

The Licensee was informed that CCL shall continue to monitor the facilities with annual facility inspection visits and as often as necessary to ensure the Licensee's compliance with Title 22 Regulations. The Licensee was also informed that further citations and/or non-compliance actions may result in a Non-Compliance Conference with the Regional Manager.



Exit interview conducted and copy of today's report was provided to the Licensee.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
LIC809 (FAS) - (06/04)
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