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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800366
Report Date: 08/26/2021
Date Signed: 08/26/2021 04:40:38 PM

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:ATRIA HILLCRESTFACILITY NUMBER:
565800366
ADMINISTRATOR:SARAH DODDFACILITY TYPE:
740
ADDRESS:405 HODENCAMP RDTELEPHONE:
(805) 373-0606
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:207CENSUS: 114DATE:
08/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Sarah DoddTIME COMPLETED:
04:39 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) Martha Guzman Chavez conducted an unannounced Required 1-year inspection at the facility today with focus on Infection Control. LPA met with Administrator Sarah Dodd and explained the reason for today's inspection. Entrance interview conducted.

At 10:45 AM LPA and Administrator began a physical plant tour to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Infection control practices were reviewed with the administrator and observed during the inspection. Required signs were observed during the inspection. LPA observed signs posted on proper hand washing etiquette. The facility's dining room and kitchen were observed. LPA observed facility had a sufficient supply of perishable and non-perishable food and food was stored at appropriate temperatures. All knives are locked inaccessible to residents. A random selection of four (4) resident rooms in assisted living and one (1) in Memory Care were observed between 10:52 AM and 11:57 AM. LPA observed the restrooms to be clean, sanitary and in operating condition with grab bars and non-skid mats inside the shower. Smoke alarms were tested in each room and were operational. The water temperature was tested and measured between 109.4 degrees F and 111.2 degrees F. LPA observed the resident bedrooms, which were furnished appropriately. Observed inside each room was a bed with clean linens, a night stand, and sufficient lighting. The carbon monoxide detector on the first floor of the facility was tested and operational. Fire extinguishers observed were fully charged and last serviced on 01/22/21. At 11:32 AM the medication room was observed. Medication is centrally stored and inaccessible to residents in care. First aid Kit and Manual were observed and complete. LPA conducted a random record review of eight (8) resident files, five (5) from Assisted Living and three (3) from Memory Care, as well as three (3) staff records.

Continued on LIC 809c
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Guzman-ChavezTELEPHONE: (818) 596-4334
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
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: ATRIA HILLCREST
FACILITY NUMBER: 565800366
VISIT DATE: 08/26/2021
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

LPA observed at least a 30-day supply of Personal Protection Equipment (PPE). LPA observed housekeeping cleaning rooms as well as common areas during plant tour. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. Facility has not had another Positive since 8/06/2021.

No deficiencies were observed during today's inspection. Exit interview conducted and report reviewed with the administrator. A copy of the report will be emailed to the administrator.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Guzman-ChavezTELEPHONE: (818) 596-4334
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2