<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561704034
Report Date: 11/09/2022
Date Signed: 11/09/2022 12:10:54 PM

Document Has Been Signed on 11/09/2022 12:10 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:CAMARILLO HEALTH CARE DISTRICTFACILITY NUMBER:
561704034
ADMINISTRATOR:MARY ANN RATTOFACILITY TYPE:
775
ADDRESS:3639 EAST LAS POSAS ROAD #117TELEPHONE:
(805) 388-1952
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY: 40CENSUS: 3DATE:
11/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:01 AM
MET WITH:Mary Ann RattoTIME COMPLETED:
12:15 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) Kelly Dulek conducted an unannounced Required - 1 Year inspection at the day program today and met with Administrator Mary Ann Ratto. This annual had a specific emphasis on infection control practices and procedures. Entrance interview conducted.

When the LPA arrived there were two participants, and two facility staff present; a third participant arrived during the visit. The LPA, along with facility staff, toured the physical plant areas to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed:
The food service area was observed. The day program serves lunch and snacks to the participants. Food was observed to be stored, prepared and served in a safe and healthful manner. Knives are stored in a locked drawers. Cleaning supplies are inaccessible to participants in care. The fire extinguisher in the kitchen was fully charged and last serviced on 09/23/2022. The fire safety inspection was last conducted on 09/01/2021 by Fire Inspector Martinez. During today's visit, Administrator contacted Inspector Martinez to schedule an annual inspection; report will be sent to LPA upon completion. There are three unisex restrooms for participant use. Restrooms were observed to be clean and sanitary and in operating condition with grab bars and hygiene supplies. At 11:11 AM the hot water temperature measured at 110.9 degrees F. There are two resting areas for participants if needed. The activity schedule was posted and supplies were observed. Medications are locked and centrally stored in the medication room.

INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening. LPA observed all staff and visitors to be wearing masks. Administrator indicated the facility has an adequate supply of Personal Protective Equipment (PPE) and is able to obtain additional supplies as needed. The Report Continued on LIC 809-C
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2022
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: CAMARILLO HEALTH CARE DISTRICT
FACILITY NUMBER: 561704034
VISIT DATE: 11/09/2022
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
facility’s cleaning protocol is sufficient. If needed, the facility has a prepared isolation room if the facility has a suspected or confirmed case of COVID-19. However, facility staff indicated that participants' family members will contact the facility and not bring the participant to program if they are feeling under the weather. The facility’s policies and procedures as it pertains to infection control are adequate.

No deficiencies were observed during today's inspection. Exit interview conducted. A copy of the report was provided via email.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2