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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800366
Report Date: 03/24/2022
Date Signed: 03/24/2022 03:08:50 PM


Document Has Been Signed on 03/24/2022 03:08 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:ATRIA HILLCRESTFACILITY NUMBER:
565800366
ADMINISTRATOR:SARAH DODDFACILITY TYPE:
740
ADDRESS:405 HODENCAMP RDTELEPHONE:
(805) 373-0606
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:207CENSUS: 111DATE:
03/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Sarah DoddTIME COMPLETED:
03:05 PM
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Licensing Program Analyst (LPA) Martha Guzman Chavez arrived at the facility unannounced to conduct a required annual visit at 11:50 a.m. This annual has a specific emphasis on infection control practices and procedures. The last annual conducted at this facility was on 8/26/2021. The LPA met with Administrator, Sarah Dodd and explained the reason for today's inspection. Entrance interview conducted.

At 12:05 p.m., the 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.

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 six (6) resident rooms in assisted living and one (1) in Memory Care were observed. The LPA observed the restrooms to be clean, sanitary and in operating condition with grab bars and non-skid mats inside the shower. The water temperature was tested and measured between 109.4 degrees Fahrenheit and 111.4 degrees Fahrenheit. The 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. Fire extinguishers observed were fully charged and last serviced on 3/22/2022. At 12:33 p.m., the medication room was observed. Medication is centrally stored and inaccessible to residents in care.

During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. The LPA observed appropriate signage which promoted good hand hygiene, physical distancing, symptoms of COVID-19, and the latest CDSS PINS pertaining to visitation.

...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: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2022
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: ATRIA HILLCREST
FACILITY NUMBER: 565800366
VISIT DATE: 03/24/2022
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...Continued from LIC 809...

The facility has a central entry point for symptom screening, temperature checks, and sanitation station. The LPA observed an adequate supply of Personal Protection Equipment (PPE). Staff were observed wearing face coverings.. The facility is in compliance regarding the requirements for indoor and outdoor visitation. Facility has not had another Positive since 3/02/2022.

Exit Interview. No deficiencies were observed during today's inspection. The report was signed by staff Lupe Ambriz. 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: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2