421700411-8-6-2024-29-AS-BPHS-D7VUTJ-20240806155201

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 421700411
Report Date: 08/06/2024
Date Signed: 08/06/2024 03:52:18 PM

Document Has Been Signed on 08/06/2024 03:52 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
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	VALLE VERDE		FACILITY NUMBER:	421700411
ADMINISTRATOR:	SUSAN E PONCE		FACILITY TYPE:	741
ADDRESS:	900 CALLE DE LOS AMIGOS		TELEPHONE:	(805) 883-4193
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93105
CAPACITY:	547	CENSUS: 329	DATE:	08/06/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Jenny Firth, Director of Human Resources		TIME COMPLETED:	04:00 PM

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On 08/06/2024 Licensing Program Analyst (LPA) Brian Phillips arrived at the facility unannounced to conduct a required annual facility site inspection visit at the facility above. When the LPA arrived, they were greeted by DIrector of Human Resources Jenny Firth as the facility administrator was not available, and informed them of the reason for the visit.

The LPA 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. This facility is a Continuing Care Retirement Community (CCRC) that consists of assisted living segment, memory care/dementia unit, and independent living segment. The facility has waivers for Hospice and Dementia, housing both non-ambulatory and ambulatory residents.

KITCHEN(S): The facility has a main kitchen for residents of the facility in the main kitchen/dining room building. The main kitchen serves residents in the assisted living and memory care segments of the facility, as those areas have dining rooms, but no full kitchens. There is a separate kitchen in a facility restaurant building connected to the resident pool area. The LPA inspected the kitchen/food service area and observed that knives/sharp instruments are stored in the kitchen are inaccessible to residents. Kitchen appliances were in operable condition and looked clean/in good repair. The LPA observed perishable items in good condition, with proper expiration dates precluding the perishable items from expiring. The facility has a sufficient supply of perishable and non-perishable food, which would last up to a week or longer as observed by the LPA. Additional perishable food items were maintained on a shelf and/or an extra freezer. The hot water temperature was measured in the kitchen at an appropriate temperature as per the regulation. Heating devices such as stoves are inaccessible to residents, as are sharps/other items that could constitute a danger to residents. The kitchen was clean and sanitary, with covered trash cans and operating ventilation systems. No toxic substances are stored in any food preparation or storage area, and all cleaning supplies for the kitchen are kept in a separate area than the food supplies. The freezer and refrigerator were both in the appropriate temperate Fahrenheit. There is enough tableware and utensils for all residents living in the facility, and enough equipment for the storage, preparation, and service of food. Continued on 809-C

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian Phillips	TELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024

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
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VALLE VERDE	FACILITY NUMBER: 421700411
	VISIT DATE: 08/06/2024

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COMMON AREAS: At the time of the visit, the main lounge(s) and dining room(s) were observed to be appropriately furnished, with all furniture in good condition. There are lounge areas/breakout areas for residents in the different facets of the facility including assisted living, independent living, memory care, and dementia care that are appropriately furnished, with all furniture being in good condition. There are multiple fireplaces on the premises, which were all covered and inaccessible. There are pianos in the common areas of the facility in good repair and operating condition. There are operating aquariums in different portions of the facility that are in good operating condition. The facility maintains a resident mail room, resident operated thrift store open to the public, a resident convenience store, fitness center for residents, and resident clinic. The facility maintained a comfortable temperature in all individual buildings inspected. Smoke detectors and carbon monoxide detectors were tested and operational at the time of the visit in each of the buildings inspected. The fire extinguishers in all buildings inspected were fully charged and are observed by LPA to be serviced annually. The LPA observed required postings throughout all common spaces including Resident Personal Rights, Resident Council Rights, and Residential Care Facility for the Elderly (RCFE) Complaint Poster(s). There are activity supplies and equipment, including reading materials for the residents in all common areas inspected. All window screens were in good repair in all of the buildings comprising the facility. There is appropriate lighting in all of the common areas of the facility. All passageways through the common areas of the facility were free of obstruction, and all stairways are well-lit with sturdy hand railings/stair chair accessibility devices. As the facility has more than 16 residents with multiple buildings and multiple stories, there is a signal system in place which was functional at the time of the inspection by the LPA.

This required annual facility site inspection cannot be completed on the initial inspection date of 08/06/2024. A Case Management – Annual Continuation will need to be completed at a later date.

Exit interview conducted. A copy of this report provided to the facility.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian Phillips	TELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024

LIC809 (FAS) - (06/04)

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