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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850209
Report Date: 02/20/2024
Date Signed: 02/20/2024 03:34:10 PM


Document Has Been Signed on 02/20/2024 03:34 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:OAKMONT OF AGOURA HILLSFACILITY NUMBER:
195850209
ADMINISTRATOR:LILIT CHAPARYANFACILITY TYPE:
740
ADDRESS:29353 CANWOOD STREETTELEPHONE:
(747) 755-5700
CITY:AGOURA HILLSSTATE: CAZIP CODE:
91301
CAPACITY:102CENSUS: 73DATE:
02/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lilit Chaparyan - Executive Director TIME COMPLETED:
03:45 PM
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Licensing Program Analysts (LPAs) Brian Balisi and Martha Arroyo arrived at the facility unannounced to conduct a required annual visit at 10:00am. Upon arrival LPAs met with Executive Director Lilit Chaparyan and explained the reason for the visit. 

The LPAs toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

The LPAs began the inspection in the kitchen/food service area at 10:27am, Knives are kept inaccessible to residents in care.  Kitchen appliances were observed to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food.  Dining room furniture were observed to be in good  condition and appeared to be relatively clean.

 LPAs inspected the common areas throughout the facility including the Activity room, Lobby, reading room, lounge, café, fitness center, and movie theatre.  The common areas include the following on the    All the rooms have been appropriately furnished. There is a dedicated area for the posting of required documents directly by the main entrance and hallway. The common areas were observed to be  properly furnished and relatively clean at the of the visit.  LPA observed appropriate signage regarding infection control posted throughout the facility.  LPA observed sanitizer readily available in areas with high touch surfaces.  At the time of the visit, living room and dining room furniture was observed to be in good condition.  The facility maintained a comfortable temperature.  All exits in Memory care have functioning auditory devices and were operational at the time of the visit. The LPAs observed required postings throughout the common spaces. 

At approximately 10:35am,  LPAs inspected five (5)  randomly selected bedrooms in memory care and assisted living.  The resident bedrooms were properly furnished with a bed, night stand, and sufficient lighting for each resident.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian BalisiTELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:
DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2024
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 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: OAKMONT OF AGOURA HILLS
FACILITY NUMBER: 195850209
VISIT DATE: 02/20/2024
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Continued from 809
The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPA observed all bathrooms in each resident bedroom  were clean, properly supplied and had functional fixtures. The hot water was measured in each bathroom within 105 - 120 degrees Fahrenheit. At approx 10:46am, Smoke detector(s) and carbon monoxide detectors were observed to be operational at the time of the visit. Fire extinguishers were observed throughout the facility,  fully charged and were last serviced Jan 10, 2024.  Resident Alert buttons were activated during the physical plant and LPAs observed staff receive the alerts in a timely manner.

Records review began at 11:30 am,  five (5) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. Five (5) personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Daily vehicle inspection list and California Highway Patrol Inspection report was reviewed for facility vehicles. All records were observed to be in order at this time.

Medications review began at approximately  12:30pm,  The medications are centrally stored in a med room on the 2nd floor inaccessible to residents in care. Medications are properly documented on the centrally stored medications and destruction record. 

Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. At this time, the staff will continue to keep up signs that promotes good hand hygiene and symptoms of a communicable disease. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of a communicable disease The facility’s policies and procedures as it pertains to infection control are adequate.

During the inspection the LPAs interviewed five (5) staff members and five (5)  residents. LPAs obtained the following documents - Census, Staff schedule, Emergency Disaster plan and updated Limited Liability insurance.

Exit interview conducted and report issued.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian BalisiTELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2