565801201-5-7-2025-29-AS-KLOZ-DGWVAH-20250522161559

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801201
Report Date: 05/07/2025
Date Signed: 05/07/2025 04:30:37 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
06/26/2024 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20240626142900

FACILITY NAME:	ABSOLUTE CARE HOME		FACILITY NUMBER:	565801201
ADMINISTRATOR:	MARIA LOURDES RICAFORT		FACILITY TYPE:	740
ADDRESS:	1601 KIPLING COURT		TELEPHONE:	(805) 986-8118
CITY:	OXNARD	STATE: CA	ZIP CODE:	93033
CAPACITY:	6	CENSUS: 2	DATE:	05/07/2025
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Maria Lourdes Ricafort		TIME COMPLETED:	04:35 PM

ALLEGATION(S):

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Staff did not ensure that resident received assistance with their colostamy bag
Staff did not meet resident's hygiene needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Esther Cortez conducted an unannounced subsequent complaint visit for the above allegations. Upon arrival, LPA met with Administrator Maria Lourdes Ricafort and explained the reason for the visit.

On 07/02/2024, between 01:45 p.m. and 3:45 p.m., the LPA interviewed the Administrator over the phone, one (1) staff in person, and staff was not able to provide records for Resident #1 (R1). During today's inspection, the LPA conducted a tour of the facility, interviewed the Administrator, one (1) staff, one (1) resident, and two (2) witnesses. During today's visit the Administrator was not able to provide records for Resident #1 (R1) which will be addressed under a seperate cover.

Report will continue on LIC9099-C, 2nd page.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20240626142900

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: 05/07/2025

NARRATIVE

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Regarding the allegations, “Staff did not ensure that resident received assistance with their colostomy bag and Staff did not meet resident's hygiene needs” it is the concern of the reporting party (RP) that in March 2024, former Resident 1 (R1) tried to change their colostomy bag, got the contents on themselves, and the owner refused to clean R1. RP further reported that the owner insisted on R1 to be placed on Home Health care to take care of baths and illnesses, and once R1 was placed on Home Health, the owner would call a different Home Health care provider to come and look at R1. During the initial complaint visit on 07/02/2024, the LPA was advised the facility only had one staff working at the facility in addition to the Administrator. Interviews with both the Administrator and the staff revealed that R1 would take care of their own colostomy bag, R1 did not ask for help, and they did not observe R1 to struggle with the colostomy bag. The Administrator further revealed that R1 did not want them to help with the colostomy bag. The Administrator stated that R1 received assistance from their Home-Health agency for anything related to their colostomy bag, they came once a week, denied ever leaving R1 with the contents of their colostomy bag on them, and stated that they always ensure all the residents are kept clean. Furthermore, the Administrator stated that they only suggest residents to be placed on home health for medical support if needed such as having a colostomy bag, denied suggesting it due to baths, and stated that they would still provided baths even if residents are on home health. Lastly the Administrator stated they cannot call a different Home Health provider that is not the assigned one to the resident, and other Home Health agencies will not touch a resident that is not assigned to them. Staff revealed that they never witnessed the Administrator leaving R1 dirty, and that the administrator would clean them or asked staff to clean the resident. The LPA was not able to review any records for R1, as the Administrator was not able to provide them which will be addressed under a separate cover. Interview with a family member of R1, revealed that they did not have any concerns regarding the care that was being provided at the home. They further revealed that they spoke with R1 once a week over the phone and R1 did not voice any concerns and sounded happy. Per Title 22 Regulations the licensee shall be permitted to accept or retain a resident who has a colostomy or ileostomy if the resident is mentally and physically capable of providing all routing care for his/her ostomy and the physician has documented that the ostomy is completely healed or if assistance in the care of the ostomy is provided by an appropriately skilled professional. Although the allegation may have happened or is valid, based on interviews, the above allegations are deemed unsubstantiated at this time.

Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025

LIC9099 (FAS) - (06/04)

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