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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197690039
Report Date: 08/29/2022
Date Signed: 08/29/2022 03:39:51 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/29/2022 03:39 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:LA VENTANA TREATMENT PROGRAMSFACILITY NUMBER:
197690039
ADMINISTRATOR:DIAHANN KLEINFACILITY TYPE:
772
ADDRESS:779 BRIAR CLIFF ROADTELEPHONE:
(805) 371-5700
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY: 6CENSUS: 4DATE:
08/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Wendy McCainTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA), Martha Arroyo conducted an unannounced visit to the above facility to conduct a Required 1-Year Annual Inspection with focus on Infection Control at 1:15 p.m. The last annual conducted at this facility was on 7/23/2021. Upon arrival, the LPA was greeted at the door by staff, Alexie Rodriguez and Bryce Colvard, and the reason for the visit was explained. The LPA was advised the Clinical Director was unavailable to come to the facility. The Director of Nursing, Wendy McMain arrived at 1:30 p.m., and the Chief Clinical Officer, Sharon Volner arrived at 1:41 p.m. Entrance interview.

At 1:33 p.m., the LPA began the physical plant tour of the common areas, kitchen area, resident bedrooms, bathrooms, and outdoor area to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

KITCHEN: Kitchen appliances were in operable condition. The facility has a sufficient supply of seven (7) days perishable and two (2) days non-perishable food. The LPA observed the hallway closet where all medications and staff/client files are locked and inaccessible to clients. BEDROOMS: The LPA observed the clients rooms, which were furnished appropriately with clean linens, furnishings, and sufficient lighting. RESTROOMS: Client restrooms are clean and sanitary and in operating condition. Restrooms are sufficiently stocked with hand liquid soap and paper towels. There are three (3) bathrooms for client use. Bathrooms were measured for hot water, the first bathroom measured at 120.2 degrees Fahrenheit at 1:39 p.m., the second bathroom measured at 122.4 degrees Fahrenheit at 1:40 p.m., and the third bathroom measured at 111.2 degrees Fahrenheit at 1:43 p.m. Staff adjusted and corrected the water temperature during visit.

…Report Continued on LIC 809C…

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2022
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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: LA VENTANA TREATMENT PROGRAMS
FACILITY NUMBER: 197690039
VISIT DATE: 08/29/2022
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…Report Continued from LIC 809...

GROUNDS: There is a covered patio area with patio furniture including a table and chairs for client use. Facility has one (1) fence gate that self-latches with clear passageways for emergency exit use. No large bodies of water accessible to clients during time of visit. COMMON SPACES: The living and dining areas are clean and properly furnished with seating, a table, and television for client use. Fire extinguisher was observed to be last serviced on 5/15/2022.

During today’s visit, the LPA spoke with Staff regarding the facility’s infection control practices. The LPA observed appropriate signage which promoted good hand hygiene, physical distancing, and symptoms of COVID-19. The LPA observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. Staff were observed wearing face coverings. All Staff are fully vaccinated and boosted. No identified staffing concerns. The facility is in compliance regarding the requirements for indoor and outdoor visitation. The facility’s policies and procedures as it pertains to infection control are adequate.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D).

Exit interview conducted. Appeal Rights Discussed. A copy of the report was provided via email.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/29/2022 03:39 PM - It Cannot Be Edited


Created By: Martha Arroyo On 08/29/2022 at 02:10 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LA VENTANA TREATMENT PROGRAMS
FACILITY NUMBER: 197690039

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/29/2022
Section Cited
CCR
87303(e)

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87303(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water… not less than 105-degree F (41 degrees C) and not more than 120-degree F (49 degrees C). This requirement is not met as evidenced by:
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The Staff adjusted the thermostat during time of visit and has agreed to submit a hot water temperature log for five (5) days to show that the hot water is being maintained between temperatures 105- and 120-degrees Fahrenheit.
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Based on LPAs observation, the facility did not comply with the section cited above as two (2) out of three (3) client restroom faucets delivers hot water measured at 120.2 and 122.4 degrees Fahrenheit, which poses an immediate health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Desaree Perera
LICENSING EVALUATOR NAME:Martha Arroyo
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2022


LIC809 (FAS) - (06/04)
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