565800551-10-18-2023-29-AS-RDLN-CWR3TQ-20231018183218

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565800551
Report Date: 10/18/2023
Date Signed: 10/18/2023 06:32:30 PM

Document Has Been Signed on 10/18/2023 06:32 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:	GABLES OF OJAI, THE		FACILITY NUMBER:	565800551
ADMINISTRATOR:	MATTEO DIGRIGOLI		FACILITY TYPE:	740
ADDRESS:	701 N. MONTGOMERY ST.		TELEPHONE:	(805) 646-1446
CITY:	OJAI	STATE: CA	ZIP CODE:	93023
CAPACITY:	118	CENSUS: 82	DATE:	10/18/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:29 AM
MET WITH:	Matteo Digrigoli, Administrator		TIME COMPLETED:	06:40 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) De Leon arrived at 10:29 am to conducted a 1 year annual visit to the facility above. LPA met Administrator Matteo Digrigoli and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Infection Control: The facility has submitted a current Infection Control Plan. The facility has a sign in and out area for visitors at entry with hand sanitizer. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. The facility has EPA approved disinfectants spray and cleaners. Trash can and wastebaskets have tight fitting lids. Infection control and PPE training for staff is completed. Operational Requirements: The facility has a current plan of operation. The facility is approved for a capacity of 118 capacity with 54 Ambulatory, 60 Non-Ambulatory, which 4 may be bedridden in the memory care building rooms 302, 306, and 307. Facility has a current Hospice wavier granted for 15. The Facility is operating in compliance with the granted fire clearance. Physical Plant & Environment Safety: The facility has 14 buildings on the licensed property. The facility has 90 apartments with bathrooms and 7 public restrooms currently occupying 82 residents and employs 41 staff. The facilities common areas were clean, safe and sanitary. Memory Care Building N is located across the street and all exiting doors and gates have alarms. LPA was authorized to enter and inspect facility. The lighting and lamps are sufficient for the use of the facility and for residents comfort. The facilities main kitchen is clean, safe and sanitary. Apartment rooms were clean and comfortable for residents use, showers have non-skid textured floors, and grab bars were secured. Toilet, hand washing and bathing facilities were operational. The pathways were clear of any obstructions. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care and kept locked. The facility has sufficient space inside and outside for activities and visiting. The facility is fenced with 3 open areas and 1 gate. The outside courtyard has plenty of shade for resident use. The facility has a pool fully fenced with 2 locked gates for entry. The facility has telephone and internet service for all residents in care. LPA toured 10 resident rooms. Toured rooms 8, 17, 33, 47, 88, 60, 302, 301, 307, and 312, all rooms met regulation requirements. Continued 809-C

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2023

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 9

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: GABLES OF OJAI, THE	FACILITY NUMBER: 565800551
	VISIT DATE: 10/18/2023

NARRATIVE

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Staffing: The facility employes 40 staff and 1 Administrator. Staff records are kept confidential. LPA reviewed 5 random staff files. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Finger print clearance/Associations/exemptions. Administrator file was reviewed for Continuing Education requirements and current Administrator Certificate expired 09/2023, Administrator has sent in renewal paperwork and is currently pending with CCL.

Personnel Records & Training: The facility keeps confidential files for each staff member. LPA reviewed 5 staff training records for Initial and/or Annual Training Requirements of 20 plus hours meeting 8 hours of dementia training with all subjects covered over a 3 year period, 4 hours of hospice care, postural supports and restricted health condition and 8 hours of other training to include ADL's, resident characteristics, emergency preparedness policy and procedures, infection control requirements and staff met most requirements with some not meeting exact hours and or subjects requirements. Administrator will make sure all staff finish annual training for 2023 with all required subjects and topics covered. Staff handling medications had annual training of 8 hours of medication training.

Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Five files were reviewed for signed Admission Agreements, Medical Assessments, LIC. 602A Physicians Report, ID and Emergency contact forms, Appraisal Needs and Services plans (ANS), TB results, Personal Rights, and Safeguard for personal property and valuables. Pre-Admission appraisals were on file. The facility does not handle cash resources for residents in care. Facility does submit incident reports to the department when required.

Resident Rights Information: All require postings were posted in the common area of the facility. Personal rights, Rights to Resident Council, and Theft and Loss policy. CCL Complaint poster was 20x26 in size. Administrator agreed to have the Memory Care poster made into a 20x26 size. The LTCO poster was posted in the common area of the facility. The current license was posted in common entryway.

Planned Activities: The facility offers activities to all residents in care. The facility employs an Activities Director and a monthly calendar with all activities is posted. The facility also offers additional activities to include books, magazines, newspapers, television, daily walks, group discussions and communications, games and puzzles. The facility has sufficient space to allow for activities indoors and outdoors as well as an activity room. Continued 809-C

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2023

LIC809 (FAS) - (06/04)

Page: 2 of 9

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: GABLES OF OJAI, THE	FACILITY NUMBER: 565800551
	VISIT DATE: 10/18/2023

NARRATIVE

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Food Service: The facility employs food service staff. The facility handles and prepares food safely. The facility has 2 day perishables and 7 day non-perishables to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food was covered, stored and marked appropriately in the main kitchen. A menu is posted for residents in care. Cleaning solutions and equipment were stored separately than food supply. Main Kitchen areas were clean and free from litter, rodents, vermin and insects. Kitchen staff were observed for personal hygiene and food sanitation practices.

Incidental Medical & Dental: The facility has 2 medication rooms both are kept locked. Facility provides or arranges transportation to medical and dental appointments when needed. The medications records were reviewed and all residents in care had a Medication Administration Record (MAR) and a Centrally Stored Medication Destruction Record (CSMDR). LPA inspected medication room for prescription and PRN medications, medication were reviewed for expirations dates. No medications labels were altered. The facility has a mini locked refrigerator. The facility has a red sharps container for disposal of syringes. Medication Destruct is done by the facility with Administrator and Medication Supervision.

Disaster Preparedness: The current emergency disaster form is posted. The fire extinguishers were charged and last inspected on 06/05/2023. Emergency exits and telephone numbers were posted. Facility is conducting quarterly disaster drills. The facility is currently having the annual fire inspection today and administrator will send certification once completed.

Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked or in accessible to residents in care. The facility does not have delayed egress in the Memory Care Building. The MC building has exiting doors alarms as well as exiting gate alarms on the courtyard gate. The facility does not currently have residents with oxygen.

Exit interview completed, copy of report printed for Administrator.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2023

LIC809 (FAS) - (06/04)

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