195850209-1-23-2023-29-AS-BBAI-CNCTSX-20230123135953

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850209
Report Date: 01/23/2023
Date Signed: 01/23/2023 02:00:01 PM

Document Has Been Signed on 01/23/2023 02:00 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 HILLS		FACILITY NUMBER:	195850209
ADMINISTRATOR:	SAHAR MOSALLA		FACILITY TYPE:	740
ADDRESS:	29353 CANWOOD STREET		TELEPHONE:	(747) 755-5700
CITY:	AGOURA HILLS	STATE: CA	ZIP CODE:	91301
CAPACITY:	102	CENSUS: 66	DATE:	01/23/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Aman Saund Health and Services Director		TIME COMPLETED:	02:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Brian Balisi arrived to this facility today to conduct a One (1) year Required inspection of this facility with emphasis on infection control practices and procedures. LPA met with Health and Services Director Aman Saund and explained the reason for the visit. Facility is a 2 story residence and consists of a total of (80) apartments. Fire clearance was approved for (94) beds for non- ambulatory residents and (8) rooms are approved for bedridden use. Fire extinguishers were observed throughout the facility and appeared to be fully charged. LPA observed fire extinguishers were last serviced in June 2022. LPA conducted physical plant tour of the facility with Aman. Randomly selected residents' bedrooms on the first and second floors were inspected. Common areas, which included lobbies, reading rooms, lounges and multiple activity areas located throughout. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. Planned activities and games were on display on tables set up in each activity area. PPE was observed to be stored in the storage area on the 2nd floor by unit 226. The kitchen appeared clean and the appliances and fixtures functional. Refrigerated and frozen foods were stored at proper temperature. There was a sufficient amount of perishable and non-perishable food at the facility and properly stored. Residents do not have access to the kitchen, dangerous items are stored inaccessible to residents. The facility menu appears to meet the daily dietary needs for residents. There were no pesticides or poisons observed near any food areas. Continued on 9099-C

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023

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 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: 01/23/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued from 809

LPA inspected (10) randomly chosen rooms during physical plant in assisted living as well as memory care wing. The resident bedrooms were observed to be properly furnished with a bed, night stand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Each bedroom had a private bathroom, LPA observed each bathroom to be clean, properly supplied and had functional fixtures. LPA observed all resident bathrooms to have grab bars and non-slip material in showers. The hot water was measured in each bathroom inspected between 109 - 112 degrees Fahrenheit.

Entry/exits were free of obstruction. The outdoor areas were clean and free of hazards. The patios and balconies have proper furnishings for outdoor use. The medications were observed inaccessible to residents in medication carts in the med rooms at this time.

On the exterior of the building, there are (3) garage storage units located on the left side of the parking lot. The first garage unit going from left to right was observed to store facility furniture, marketing items and extra appliances. The other (2) units are for (2) residents who store their vehicle. The is pet relief area and gardening area for residents use located in the rear of the facility. A storage unit in the rear was observed to house gardening supplies and was inaccessible to residents at this time. LPA did not observe any obstructions or hazardous items to residents in care at this time.

The LPA spoke with Aman regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. 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 each resident who test positive to isolate in their private room. COVID-19 testing is conducted weekly if anyone shows any symptoms. The facility’s policies and procedures as it pertains to infection control are adequate at this time.

No deficiencies cited. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2