Elisabeth Care Home

Type of visit: Required - 1 Year

On 05/27/2026 at 2:00 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Licensee/Administrator/Caregiver, Obed D'Autruche and explained the purpose of the visit. The facility’s fire clearance was approved for capacity of six (6) residents. All may be non-ambulatory, one (1) bedridden, two (2) hospice. Administrator Certificate # 7008942740 expires 01/15/2028. LPA toured facility with Mr.D'Autruche including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of five (5) total bedrooms which four (4) bedrooms are occupied by the residents and one (1) bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 70 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 100.9 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one-week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. LIC809-C Continued... Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 05/29/2025. Emergency Disaster Plan was last posted on 05/27/2026. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 03/28/2026. LPA reviewed two (2) residents records. LPA reviewed four (4) staff records and 4 of 4 have current first aid training and associated to the facility. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 3:10pm lock on side gate At 3:12pm gardening shovel/rake sitting up against backyard fence and black metal laying on ground up against the house At 3:13pm a television sitting on ground outside by garbage cans Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 06/03/2026: LIC 308 Designation of Administrative Responsibility - Reviewed LIC 309 Administrative Organization - Reviewed Updated LIC 500 Personnel Report LIC 610E Emergency Disaster Plan - Reviewed Liability Insurance - Reviewed Current Administrator’s Certificate - Reviewed Exit interview conducted, a copy of this report provided, LIC421FC civil penalties along with Appeal rights.the state’s words, verbatim · CDSS document, May 27, 2026

The state marks this report as 9 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: POC

On 06/13/2025 at 2:30 PM, Licensing Program Analyst (LPA) L. Alexander conducted an unannounced Proof of Correction (POC) visit and met with Licensee/Administrator, Obed D’Autruche. LPA explained the purpose of the visit to Licensee. On 05/28/2025, LPA L. Alexander conducted an Annual Inspection in which deficiencies were cited. The POC due date was 06/11/2025. Facility has the following deficiencies that was cleared: CCR 87465(d) CCR 87303(e)(2) Facility has the following deficiencies that was not cleared: 3. CCR 87412(a) $100.00 x’s 2 days = $200.00 4. HSC 1569.625(b)(2) $100.00 x’s 2 days = $200.00 5. CCR 87465(e) $100.00 x’s 2 days = $200.00 Civil Penalties in the total amount of $600.00 is assessed today for failure to meet POC date for deficiencies. Facility is subject to ongoing daily civil penalties until deficiencies is corrected. Exit interview conducted. A copy of this report, appeal rights and LIC421FC provided.the state’s words, verbatim · CDSS document, Jun 13, 2025

Type of visit: Required - 1 Year

On 05/28/2025 at 3:10 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Licensee/Administrator, Obed D'Autruche and explained the purpose of the visit. The facility’s fire clearance was approved for capacity of six (6) non-ambulatory and where one (1) bedridden resident can reside in Bedroom #1. Hospice waiver approved for two (2) residents. Administrator certificate #7008942740 expires 01/15/2026. LPA toured facility with Obed including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of five (5) total bedrooms which one (1) bedroom is occupied by one (1) resident and two (2) bedrooms are occupied by live-in staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 74 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 126, 128 and 128.7 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Sharps were locked and inaccessible to residents. LIC809-C Continued... LIC809-C Continued... Smoke and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 05/08/2024. Emergency Disaster Plan was last posted on 05/28/2025. Emergency disaster drill was last conducted on 03/15/2025. LPA reviewed one (1) resident's records. LPA reviewed three (3) staff records and three (3) of four (4) have current first aid training and associated to the facility. LPA reviewed a sample of resident’s medications. THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: LPA observed wooden coat rack, piece of wood lumbar, and other materials along the outside fence and back yard LPA observed a bed with sheets/blanket/pillows located in the garage LPA observed the flooring in rear bathrooms and shower were not clean LPA observed piece of wood flooring broken at rear bathroom Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 06/04/2025: Updated LIC 500 Personnel Report LIC 610E Emergency Disaster Plan - Reviewed Certificate of Liability Insurance The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, May 28, 2025

The state marks this report as 12 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: POC

On 09/19/2024, at 9:10 AM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct Case Management - Proof of Correction (POC) visit. LPA met with Licensees/Administrator, Obed & Magdala D'Autruche and explained the purpose of the visit. During the Non-Compliance Conference (NCC) meeting on 09/03/2024 the Licensees agreed to do the following in order to bring the facility in compliance. Licensee to complete a total of 6 hours (2 hours minimum for each training course) of training that included: Reporting Requirements, Administrator Qualifications and Criminal Record Clearance. Trainings are to be provided by a Community Care Licensing approved vendor. Certificate of completion due 09/17/2024. Administrator to send a copy of Admissions procedures for new residents to the Department to be mailed by 09/17/2024. The Licensee/Administrator requested an extension to the due date 09/17/2024 for 3 additional days in which LPA L. Alexander denied the request. The reason for additional days was not justifiable to show progress and effort in restoring compliance. LIC809-C Continued... LIC809-C Continued... Civil Penalties in the total amount of 2 days X $100.00 = $200.00 is assessed today for failure to meet POC date. Facility is subject to ongoing daily civil penalties until deficiencies is corrected. Exit interview conducted. A copy of this report, appeal rights provided and LIC421FC provided.the state’s words, verbatim · CDSS document, Sep 19, 2024

Type of visit: POC

On 07/26/2024, at 9:00 AM, Licensing Program Analysts (LPAs) L. Alexander and L. Holmes arrived unannounced to conduct Proof of Correction (POC) visit. LPAs met with Licensees/Administrator, Obed & Magadala D'Autruche and explained the purpose of the visit. LPAs toured the entire facility including all bedrooms, bathrooms and garage. Licensees were cited and assessed immediate civil penalties on 07/17/2024 for CCR 87355(e). LPAs did not observe any additional individuals at the facility that weren't associated in Guardian. Magadala e-mailed LPA on 07/18/2024 to advise that her family relatives were removed from the facility and are no longer residing at the facility. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 26, 2024

Allegation investigated: . Facility staff are not keeping the facility at a comfortable temperature for residents

On 07/17/2024, at 11:30 am, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct complaint investigation visit for the above allegation. LPA met with Administrator, Obed D'Autruche and explained the reason for the visit. Licensee, Magdala D'Autruche, also was present at the facility. Allegation: Facility staff are not keeping the facility at a comfortable temperature for residents Unsubstantiated. On 07/15/2024 LPA spoke with Reporting Party (RP) and they indicated that Staff 1 (S1) was not adhering to an mediated agreement between R1, W1 and S1 pertaining to the Central Air Conditioning (AC) and bedroom temperature for R1. LIC9099-C Continued... Unsubstantiated LIC9099-C Continued... LPA interviewed S1 that stated R1 wants the air to be cold and circulating all the time. S2 stated that R1 had a "private AC" but they took it out because it was expensive. S2 stated that R1's blinds are closed. S1 stated that on 07/09/2024 him and S2 were away from the facility but caregiver S3 was at the facility. S1 stated that he received a call from R1 regarding the temperature and that he spoke with S3. S1 stated that S3 said "...I don't know how to adjust the temperature..." S1 stated that he also spoke with his daughter, S4, who went and adjusted the temperature control. S1 stated when he returned back to the facility later that day, the temperature was good. LPA interviewed R1 that stated on 07/09/2024 his room was hot during the excessive heat conditions during the last couple of weeks. R1 stated that S1 was gone from the facility with guests and that he called S1 3 times that day and no answer. R1 stated that they requested to S3 if they could turn the air temperature on but S3 refused. R1 stated "I need a lot of air." R1 stated that they had their own "Energy Efficient" personal AC that included a fan and humidifier which was installed by W2 in their bedroom. R1 stated after he was discharged and returned back from his last hospitalization, 05/21/24 thru 05/28/24, his personal AC was gone without any notice or explanation to why it was removed. R1 stated that his room is hotter than all the other rooms in the house, the location where his room is facing and that there is no cross ventilation in his bedroom. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation are UNSUBSTANTIATED. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 17, 2024 · control 15-AS-20240711093341

Type of visit: Case Management - Deficiencies

On 07/17/2024 Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Case Management - Deficiency. LPA met with Obed D'Autruche, and explained the purpose of the visit. When LPA arrived to facility to conduct a complaint investigation (Control#15-AS-20240711093341). Upon entry into the facility, LPA was greeted by an individual and observed 2 (two) individuals sitting down on the couch in the living room area, 1 (one) individual standing in the kitchen area. LPA observed 1 (one) resident sitting at the dining room table, and 2 (two) other family members not including the Licensee and Administrator, Obed & Magdala D'Autruche. LPA had a conversation with Magdala regarding the observed individuals. Magdala stated that her family was visiting from Haiti and that they were not living at the facility but "Visiting." LPA spoke with Obed regarding their family guests. Obed stated that their family relatives have been "visiting" for about 2 weeks and that they are planning to receive work permits within the next 2 weeks. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in continuing civil penalties. Immediate Civil Penalty Assessed today for $3,000.00 Exit interview conducted. A copy of this report, appeal rights provided and LIC421BG was given to Licensee/Administrator.the state’s words, verbatim · CDSS document, Jul 17, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e) · Plan of correction due date: Jul 18, 2024

(e) All individuals subject to a criminal record review...Health and Safety Code Section 1569.17(b) shall prior to working, residing in a licensed facility: Based on observation and interview the licensee did not comply with the section cited above in by not having fingerprint clearance for 6 (six) family relatives that are residing at the facility submitted to CCLD which poses a potential health, safety or personal rights risk to persons in care. Immediate Civil Penalty Assessed of $3,000.00the state’s words, verbatim · CDSS document, Jul 17, 2024

Plan of correction: Administrator will have all uncleared individuals removed from the house by POC due date.

Type of visit: Case Management - Deficiencies

On 07/17/2024 Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Case Management - Deficiency. LPA met with Obed D'Autruche, and explained the purpose of the visit. LPA arrived to facility to conduct a complaint investigation (Control#15-AS-20240711093341) and during the visit LPA also discussed the deficiency not cleared. LPA discussed the deficiency and not receiving requested supported documents for foley catheter exception request which was cited on 05/29/2024. Administrator and Licensee gave several pages of documents in which LPA scanned with personal portable printer. LPA advised that documents will have to be reviewed. Licensee stated that they will send a revised exception request letter and a list of staff training to LPA via e-mail today. Facility has the following deficiencies that was not cleared: 87616(b) = 30 days X $100.00 = $3,000.00 Civil Penalties in the total amount of $3,000.00 is assessed today for failure to meet POC due date for deficiencies. Facility is subject to ongoing daily civil penalties until deficiencies is corrected. Exit interview conducted. A copy of this report, appeal rights and LIC421FC provided.the state’s words, verbatim · CDSS document, Jul 17, 2024

Type of visit: POC

On 06/18/2024, at 4:15 PM, Licensing Program Analysts (LPAs) L. Alexander and L. Holmes arrived unannounced to conduct Proof of Correction (POC) visit. LPAs met with Licensee, Magadala D'Autruche and explained the purpose of the visit. Magadala phoned Administrator, Obed D'Autruche to inform. Obed arrived at the facility shortly after. Administrator requested an extended due date from 06/05/24 to 06/12/24 in which LPA L. Alexander granted. Facility has the following deficiencies that was not cleared: 87616(b) = 6 days X $100 = $600.00 Civil Penalties in the total amount of $600.00 is assessed today for failure to meet POC date for deficiencies. Facility is subject to ongoing daily civil penalties until deficiencies is corrected. Exit interview conducted. A copy of this report, appeal rights provided and LIC421FC provided.the state’s words, verbatim · CDSS document, Jun 18, 2024

Type of visit: Required - 1 Year

On 05/29/2024 at 1:05 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Obed D'Autruche and explained the purpose of the visit. The facility’s fire clearance was approved for capacity of 4 (four) and hospice waiver for 2 (two). Administrator Certificate # 6030033740 expired 01/15/2024. Administrator stated that he submitted his renewal application which was dated 04/01/2024. LPA toured facility with Obed including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms which 2 bedrooms are occupied by the residents and 3 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 77 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 113.5 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 05/08/2024. Emergency Disaster Plan was last posted on 05/29/2024. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 03/28/2024. LIC809-C Continued... LIC809-C Continued... LPA reviewed 3 residents records. LPA reviewed 3 staff records and 3 of 3 have current first aid training and associated to the facility. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 06/05/2024: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, May 29, 2024

The state marks this report as 8 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.