565800978-8-3-2021-29-AS-ASMH-C5JNKX-20210803103240

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565800978
Report Date: 08/03/2021
Date Signed: 08/03/2021 10:33:04 AM

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:	UNIVERSITY VILLAGE THOUSAND OAKS		FACILITY NUMBER:	565800978
ADMINISTRATOR:	ESTRIN DMITRY		FACILITY TYPE:	741
ADDRESS:	3415 CAMPUS DRIVE		TELEPHONE:	(805) 241-3000
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	514	CENSUS: 470	DATE:	08/03/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Dmitry Estrin		TIME COMPLETED:	10:40 AM

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) Ashley Smith arrived unannounced to conduct a required annual visit, which has an emphasis on infection control practices and procedures. The LPA spoke with Executive Director Dmitry Estrin over the phone and informed them of the reason for the visit. Mr. Estrin arrived shortly after.

The LPA, along with staff, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and community is in compliance with Title 22 Regulations. This community is an Independent Living section of the Continuing Care Retirement Community (CCRC). The facility is a gate-guarded community with 24-hour security. There are 4 main buildings: Lakeview, Creekview, Mountainview and Gardenview. Upon entry, the community has a central entry point at the gate for symptom screening and temperature checks for residents, staff, and visitors. Residents and staff were observed wearing appropriate face coverings.

The Clubhouse has a commercial kitchen, the dining rooms, and various activity rooms. The community has a swimming pool and a spa, both of which are appropriately fenced with self-locking gates. The community also has a fitness center and a theater. Throughout today’s visit, the LPA observed appropriate signs in common areas that promoted hand hygiene, physical distancing, and cough/sneeze etiquette. In addition, the LPA observed hands-free hand sanitizer interspersed throughout the common grounds.

During today’s visit, the LPA spoke with the Executive Director regarding the community's infection control practices. The community has an adequate supply of Personal Protection Equipment (PPE) and is able to obtain additional supplies. The community's cleaning protocol is sufficient. The Executive Director sends out updates pertinent to the community's infection control practices via mass voice messaging and weekly newsletters to the residents and next-of-kin. As residents that reside in this community are independent, should a confirmed case of COVID-19 arise, residents can be appropriately isolated in their individual apartments. The community's policies and procedures as it pertains to infection control are adequate.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021

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 1