197610183-9-28-2022-31-AS-APAA-CJPVQE-20220928163812

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610183
Report Date: 09/28/2022
Date Signed: 09/28/2022 04:38:43 PM

Document Has Been Signed on 09/28/2022 04:38 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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	OAKMONT OF VALENCIA		FACILITY NUMBER:	197610183
ADMINISTRATOR:	CYNTIA DRACHENBERG		FACILITY TYPE:	740
ADDRESS:	24070 COPPER HILL DRIVE		TELEPHONE:	(661) 568-6080
CITY:	VALENCIA	STATE: CA	ZIP CODE:	91354
CAPACITY:	144	CENSUS: 102	DATE:	09/28/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Cyntia Drachenberg, Executive Director		TIME COMPLETED:	04:00 PM

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Licensing Program Analyst (LPA) Angela Panushkina conducted an Annual Required visit and inspection of the facility. LPA met with an Executive Director and explained the reason for the visit.

Infection Control: Upon arrival, LPA observed staff were wearing proper face masks.

At 11:20am, LPA toured the facility and observed the following: The facility is a large 2 story building with two (2) Memory Care Units (Tradition 1 and Tradition 2). In the main entrance of the building there is a cafe that is a self-serving refreshment and snack area with seating. The main living room has seating and a grand piano for entertainment. There is a reading room and private dining area for family or visitors to use.

Food Inspection: Kitchen and dining area are located on the ground floor of the facility. LPA observed there was sufficient stock of one week non-perishable foods and two days perishable food. Kitchen was observed to be sanitary and free of pests.

Smoke detectors/carbon monoxide are hardwired and located throughout the facility. Fire alarms are program to dispatch the Fire Department. Therefore, LPA obtained paperwork for the last fire alarm inspection which was conducted on 09/28/2022. Fire extinguishers were observed to be charged with a service date of 07/11/2022.

Common Areas: Common areas consists of front lobby sitting area, activity rooms, in Assistance Living, and Memory Care Units. All areas were properly furnished and sanitary with sufficient room for residents to lounge. Facility also has a beauty salon, gym and a theater for residents. Laundry area is located on a second floor of the facility. Facility has three (3) MedTech rooms, two (2) are located inside the Memory Care Unit and one (1) room is on an Assisted Living side. LPA observed all rooms were kept locked and inaccessible to residents in care. Continue on LIC809-C

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: OAKMONT OF VALENCIA	FACILITY NUMBER: 197610183
	VISIT DATE: 09/28/2022

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Resident Rooms: Facility consists of 86 rooms. Rooms consists of single or shared occupancy. A random selection of bedrooms was toured both in Memory Care and Assisted Living. All bedrooms were properly furnished and had appropriate bed linens. Rooms were observed to be sanitary.

Bathrooms: Bathrooms were toured and observed to be clean and properly stocked with towels and soap. Nonskid mats and grab bars were observed in all bathrooms.

Resident Files: LPA conducted a file review of resident records to ensure compliance of licensing forms.

Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms.

Medications: Medication and Medication Records were reviewed for proper documentation.

Outside: LPA toured the outside area of the facility. LPA observed two private patios with appropriate outside furniture and shaded area for residents.

No deficiencies cited. Exit interview conducted. Report signed and delivered.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

LIC809 (FAS) - (06/04)

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