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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561704034
Report Date: 11/21/2024
Date Signed: 11/21/2024 01:19:06 PM

Document Has Been Signed on 11/21/2024 01:19 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:CAMARILLO HEALTH CARE DISTRICTFACILITY NUMBER:
561704034
ADMINISTRATOR/
DIRECTOR:		MARY ANN RATTOFACILITY TYPE:
775
ADDRESS:3639 EAST LAS POSAS ROAD #117TELEPHONE:
(805) 388-1952
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY: 40CENSUS: 7DATE:
11/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Mary Ann RattoTIME VISIT/
INSPECTION COMPLETED:
01:15 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) Valeria Conway conducted an unannounced Required Annual inspection at the day program today and met with Program Director Mary-Ann Ratto. Entrance interview conducted.

When the LPA arrived, there were six (6) participants and five (5) staff present. Beginning at 09:27 A.M., the LPA, along with Administrator and Activity Coordinator, Amy Bukal, 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 fire safety inspection related to the facility's pull system was last conducted on 02/16/2024 and no violations were observed at that time. Carbon Monoxide Detector was tested at 10:55 A.M. and functioned properly.

Kitchen/Food Service: The food service area was observed. The day program serves lunch and snacks to the participants. Menu is posted. Food was observed to be stored, prepared and served in a safe and healthful manner. Knives are stored in a locked drawer. Cleaning supplies are locked in a cabinet under the sink. The fire extinguisher in the kitchen was fully charged and last serviced on 10/31/2024.

Restrooms: 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. LPA measured the hot water in participant restroom, which measured within the required range.

Common Areas: The facility contains a dining room/activity area, as well as an additional activity area, indoor gardening center and two (2) resting areas for participants if needed. The activity schedule was posted, and supplies were observed. The required postings were observed.

Continued on LIC 809-C

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: CAMARILLO HEALTH CARE DISTRICT
FACILITY NUMBER: 561704034
VISIT DATE: 11/21/2024
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
Continued from LIC 809

Medications: Medication room was observed to contain a lockbox inside a locked cabinet. Medication records are also stored inside the cabinet. First aid kit was observed to be complete.

Record Review: Staff and participant records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, participant physician's report, needs and service appraisal, and personal rights. All five (5) staff files and six (6) participant files observed were in compliance with regulation.

During today’s visit, the LPA reviewed the facility's infection control plan. LPA requested the following documents: Personnel Record (LIC 500), Participant roster, and last emergency drill. Last emergency drill was conducted on 10/24/2024.

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

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2