197607372-3-25-2024-29-AS-MARO-D3PU3M-20240325151345

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197607372
Report Date: 03/25/2024
Date Signed: 03/25/2024 03:14:05 PM

Document Has Been Signed on 03/25/2024 03:14 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:	OAKVIEW		FACILITY NUMBER:	197607372
ADMINISTRATOR:	JEANNETTE RUGGIERO		FACILITY TYPE:	740
ADDRESS:	3557 CAMPUS DR.		TELEPHONE:	(805) 241-2000
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	63	CENSUS: 48	DATE:	03/25/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Jeannette Ruggiero		TIME COMPLETED:	03:20 PM

NARRATIVE

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Licensing Program Analysts (LPAs) Teresa Camara and Martha Arroyo arrived unannounced to conduct a required annual visit. The last annual conducted at this facility was on 01/13/2023. Upon arrival, LPAs met with Executive Director, Jeannette Ruggiero, and explained the reason for the visit. Entrance interview.

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

KITCHEN: At the time of the visit, there was a sufficient supply of perishable and nonperishable food. Refrigerator, freezer, and pantry area were observed; food labels were inspected and checked for dates and expiration dates, and food labels had dates clearly marked. The facility also has an emergency supply of food and water. The weekly menu was posted by the dining room entrance. Appliances appeared to be in operable condition.

COMMON AREAS: The facility is a two story building; units are designated for assisted living residents on the first and second floor, and a separate unit on the first floor is designated for dementia residents. There were no obstructions and/or tripping hazards observed. The facility maintains a comfortable temperature. The fire extinguishers were charged and last serviced 01/13/2024. Smoke Detectors and Carbon Monoxide detectors were tested within the past 12 months and were operable. Facility elevator was operating properly. There are four (4) stairwells that all have emergency evacuation chairs.

ACTIVITIES: Planned activities are offered, and the activity schedule was posted. Activity rooms and common spaces appeared clean and in good repair.

Continued on LIC 809C...

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024

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

LIC809 (FAS) - (06/04)

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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: OAKVIEW	FACILITY NUMBER: 197607372
	VISIT DATE: 03/25/2024

NARRATIVE

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Continued from LIC 809...

BEDROOMS: LPAs toured ten randomly chosen rooms; three (3) in memory care, and seven (7) in assisted living. Rooms appeared clean, well kept, with sufficient lighting and appropriately furnished.

RESTROOMS: Restrooms on all floors were clean and sanitary. Restrooms were fully stocked with supplies. The hot water temperature was tested on all floors and ranged from 109.2- and 120-degrees Fahrenheit.

OUTSIDE AREAS: LPAs observed appropriate outdoor furniture with a covered shaded area for residents. There was an enclosed patio for residents who reside in the memory care unit. There was a water waterfall; however, water level was compliant at the time of the visit.

RECORDS: LPA’s reviewed Resident Records at 12:27 p.m. and Personnel Records at 11:40 a.m.

Five (5) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All records were in order.

Five (5) personnel files and the current Executive Director’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order.

The facility has a comprehensive disaster plan. The last fire inspection was completed on 12/27/2023 and was found to be in compliance with Fire Code Regulations at the time of inspection. Emergency disaster drills are conducted quarterly as per regulation; the last one being a fire drill and was conducted on 01/26/2024.

Continued on LIC 809C...

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024

LIC809 (FAS) - (06/04)

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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: OAKVIEW	FACILITY NUMBER: 197607372
	VISIT DATE: 03/25/2024

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Continued from LIC 809C...

MEDICATIONS: Medications review began at approximately 2:17 p.m.; medications are centrally stored in the medication room; there is a medication room on each of the two (2) floors. PRNs have physicians order on file. Medications appeared to be given as prescribed.

INTERVIEWS: LPAs interviewed three (3) residents and three (3) staff members during the inspection; no concerns were noted.

Exit interview conducted. No deficiencies cited. Report was reviewed and a copy was provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024

LIC809 (FAS) - (06/04)

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