565800476-6-16-2022-29-AS-JROS-CFG4FT-20220616190427

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565800476
Report Date: 06/16/2022
Date Signed: 06/16/2022 07:48:37 PM

Document Has Been Signed on 06/16/2022 07:48 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 LAS POSAS		FACILITY NUMBER:	565800476
ADMINISTRATOR:	ROBLOE BABASANTA		FACILITY TYPE:	740
ADDRESS:	24 LAS POSAS RD		TELEPHONE:	(805) 987-9872
CITY:	CAMARILLO	STATE: CA	ZIP CODE:	93010
CAPACITY:	140	CENSUS: 115	DATE:	06/16/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:35 PM
MET WITH:	Robloe Babasanta		TIME COMPLETED:	07:09 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) JoAnn Rosales conducted an unannounced Required -1 Year inspection. LPA met with Administrator Robloe Babasanta. During facility tour to inspect for infection control practices LPA observed one central entry point designated for universal entry screening. Cleaning supplies were observed and infection control practices were discussed. An inspection of the common area, resident rooms and restrooms were conducted hot water temperature (read at 110.8, 113.5, 113.9 and 110.3 degrees F.) in resident bathrooms. Grab bars were present in the bathrooms. Hygiene items are being provided. LPA observed a sufficient supply of perishable and nonperishable food. LPA observed working signal system. LPA observed appropriate lighting in the facility. LPA observed the fire extinguishers fully charged. The smoke alarms and carbon monoxide detectors were tested and were operable. Disinfectants and cleaning supplies were in a locked housekeeping room. Medications were centrally stored and are kept in locked medication carts and locked medication rooms. LPA observed a sufficient supply of PPE. Outdoor area toured- passageways are free of obstruction. During facility tour at 3:38 pm with Administrator LPA observed a maintenance cart outside of the Maintenance Directors office with a saw, a drill, ceiling paint & primer accessible to residents. During facility tour at 3:41 pm with Administrator LPA observed scissors, dry contacts lens drops, and alcohol wipes in staff #1 (S1)'s office accessible to residents as the door was left open. During facility tour at 4:05 pm with Administrator LPA observed shaving lotion in memory care residents bathroom room #136 accessible to residents. Continued on 809C

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Joann Rosales	TELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022

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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ATRIA LAS POSAS	FACILITY NUMBER: 565800476
	VISIT DATE: 06/16/2022

NARRATIVE

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During facility tour at 4:18 pm with Administrator LPA observed antibacterial hand wipes in memory care resident room #140 accessible to residents.

During facility tour at 4:38 pm with Administrator LPA observed antibacterial all purpose cleaner in staff dining area accessible to residents.

During facility tour starting at 4:40 pm with Administrator LPA observed staff #2 (S2)'s metformin tablets and scissors in S2's office accessible to residents as the door was left open.

During facility tour starting at 4:46 pm with Administrator LPA observed wine, vodka, whiskey, tequila and champagne in cabinets in the Happy Hour Cafe accessible to residents. Administrator stated that they did not realize that the locks were missing from the cabinets.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D):

Exit interview conducted, todays reports and appeals rights were reviewed and emailed to the Administrator.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Joann Rosales	TELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/16/2022 07:48 PM - It Cannot Be Edited

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 LAS POSAS	FACILITY NUMBER: 565800476
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/16/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87309(a)

Storage Space

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's observations and record review, the licensee did not comply with the section cited above as S2's medication and S1's contact lens drops were accessible to residents which poses an immediate health risk to persons in care.
	POC Due Date: 06/16/2022
	Plan of Correction
1 2 3 4	Administrator locked S1 and S2's doors during facility visit. Administrator stated that they will provide documentation of staff inservice regarding regulation 87309(a) to CCL by 6/24/22.

Type A

Section Cited

CCR

87705(f)(1)

Care of Persons with Dementia

(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's observations and record review, the licensee did not comply with the section cited above tools and scissors were accessible to residents which poses an immediate health and safety risk to persons in care.
	POC Due Date: 06/17/2022
	Plan of Correction
1 2 3 4	Staff placed maintenance cart in an inaccessible location during facility visit, Administrator locked S1 and S2's offices during facility visit. Administrator stated that they will provide documentation of staff inservice regarding regulation 87705(f)(1) to CCL by 6/24/22.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Joann Rosales	TELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 06/16/2022 07:48 PM - It Cannot Be Edited

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 LAS POSAS	FACILITY NUMBER: 565800476
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/16/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87705(f)(2)

Care of Persons with Dementia

(f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's observations and record review, the licensee did not comply with the section cited above as alcohol and toxic substances were accessible to residents which poses an immediate health risk to persons in care.
	POC Due Date: 06/17/2022
	Plan of Correction
1 2 3 4	Staff placed toxic items in an inaccessible location during facility visit. Administrator stated that they will have staff remove alcohol from Happy Hour Cafe and will submit documentation to CCL by 6/17/22. Administrator stated that they will provide documentation of staff inservice regarding regulation 87705(f)(2) to CCL by 6/24/22.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Joann Rosales	TELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022

LIC809 (FAS) - (06/04)

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