565800476-6-14-2024-29-AS-TCAA-D68W2X-20240614165504

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565800476
Report Date: 06/14/2024
Date Signed: 06/14/2024 04:55:48 PM

Document Has Been Signed on 06/14/2024 04:55 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:	ATRIA LAS POSAS		FACILITY NUMBER:	565800476
ADMINISTRATOR:	ROMAN SIERRA TOVAR		FACILITY TYPE:	740
ADDRESS:	24 LAS POSAS RD		TELEPHONE:	(805) 987-9872
CITY:	CAMARILLO	STATE: CA	ZIP CODE:	93010
CAPACITY:	140	CENSUS: 108	DATE:	06/14/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:58 AM
MET WITH:	Roman Sierra Tovar		TIME COMPLETED:	05:10 PM

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Licensing Program Analyst (LPA) Teresa Camara conducted a required annual visit. LPA met with Executive Director Roman Sierra Tovar and discussed the reason for the visit.

LPA 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.

Fire extinguishers were last serviced on 10/11/2023. The maintenance director provided documentation of monthly smoke detector and carbon monoxide detector inspections throughout the facility. Batteries in the detectors are changed once a year. Johnson Controls inspected the fire sprinkler system 3/26/2024 and the fire alarm 5/30/2023. No concerns observed.

COMMON SPACES: In the common areas, walls, flooring, and furnishings were checked for cleanliness and good condition. Fireplaces were observed to be adequately screened. LPA observed the required postings in the common hallway and throughout the building. All hallways and egresses were observed to be free of obstructions.

KITCHEN: Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. The facility also has a sufficient supply of emergency food and water. 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: LPA observed eight resident bedrooms in Assisted Living and two resident bedrooms in Life Guidance (Memory Care,) which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.

Report continued on LIC 809 - C

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024

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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ATRIA LAS POSAS	FACILITY NUMBER: 565800476
	VISIT DATE: 06/14/2024

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(continued from LIC809)

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. The hot water temperature was tested in four resident restrooms and all measured above the allowable regulatory range. Temperatures were measured as follows: 134*F, 125.8*F, 122.4*F, and 125.6*F. During the visit the maintenance director stated the facility had just received maintenance on the boiler and the technician may have increased the water temperature. The maintenance director adjusted the hot water temperature during LPA's visit.

INFECTION CONTROL/EMERGENCY DISASTER: 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: LPA interviewed ten (10) residents.

No citations were issued during today’s visit. An annual continuation visit will be necessary and any deficiencies observed will be cited during that visit. Exit interview conducted and report issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024

LIC809 (FAS) - (06/04)

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