565800476-6-14-2023-29-AS-KDUK-CST3F4-20230614181208

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565800476
Report Date: 06/14/2023
Date Signed: 06/14/2023 06:12:24 PM

Document Has Been Signed on 06/14/2023 06:12 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: 125	DATE:	06/14/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:42 AM
MET WITH:	Robloe Babasanta		TIME COMPLETED:	06:20 PM

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Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 11:42AM. The LPA met with Executive Director Robloe Babasanta and discussed the reason for the visit. Entrance interview conducted.

Beginning at 12:03PM, the LPA, along with Executive Director, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The following was observed:

COMMON SPACES: In the common areas, walls, flooring, and furnishings were checked for cleanliness and good condition. At the time of the visit all common areas were observed to be in good condition. Fireplaces were observed to be adequately screened. The LPA observed the required postings in the common hallway and throughout the building. Fire extinguishers were observed to be fully charged and last serviced on 10/22/2022. All hallways and egresses were observed to be free of hazards. Carbon monoxide detectors in common areas were tested and were functional at the time of the visit.

KITCHEN: Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food, and emergency supply. All knives and cleaning supplies were observed to be properly stored at the time of the visit.

OUTDOOR SPACES: Outdoor spaces in both Assisted Living and Life Guidance were observed. Both contain shaded outdoor areas equipped with furniture for resident use.

BEDROOMS: The LPA observed 8 (eight) resident bedrooms in Assisted Living and 2 resident bedrooms in Life Guidance (Memory Care,) which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 123 total bedrooms, all which are private; 107 are assisted living resident

Report continued on LIC 809 - C

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023

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: 06/14/2023

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rooms and 16 (sixteen) are Life Guidance resident rooms. Smoke detectors were tested in various rooms observed and functioned properly at the time of the visit. Pendants were tested in randomly selected rooms throughout the visit; all tested were functional and staff response time was adequate.

RESTROOMS: Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. LPA observed sufficient amounts of soap and paper products in each restroom. Water temperature was tested in all 10 (ten) resident restrooms observed and were all in compliance with regulation.

RECORD REVIEW: LPA reviewed staff and resident records for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisals, and admission agreements. 5 (five) of 5 (five) staff files reviewed contained all documents. 5 (five) resident files were reviewed and all 5 (five) of 5 (five) files were observed to be in compliance with regulation.

INFECTION CONTROL/EMERGENCY DISASTER: During today’s visit, the LPA reviewed with the Executive Director the facility’s infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control and emergency disaster planning are adequate.

INTERVIEWS: Throughout today’s visit, LPA interviewed 3 (three) staff and 3 (three) residents.

MEDICATION REVIEW: Began at 05:13PM. Medications for 3 (three) residents were reviewed. All prescription medications reviewed for all 3 (three) residents were in compliance with regulation. 1 (one) of 3 (three) residents' medications reviewed contained Over the Counter medications, which were centrally stored, but not labeled in compliance with regulation.

No citations were issued during today’s visit. Exit interview conducted. A copy of the report was provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023

LIC809 (FAS) - (06/04)

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