565800978-9-29-2026-29-AS-BBAI-DYDSM5-20260929135921

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565800978
Report Date: 09/29/2026
Date Signed: 09/29/2026 01:59:52 PM

Document Has Been Signed on 09/29/2026 01:59 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:	UNIVERSITY VILLAGE THOUSAND OAKS		FACILITY NUMBER:	565800978
ADMINISTRATOR/ DIRECTOR:	JEANNETTE RUGGIERO		FACILITY TYPE:	741
ADDRESS:	3415 CAMPUS DRIVE		TELEPHONE:	(805) 241-3000
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY: 514		CENSUS: 487	DATE:	09/29/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Jeannette Ruggiero		TIME VISIT/ INSPECTION COMPLETED:	02:30 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 Analysts (LPAs), Brian Balisi and Martha Arroyo conducted an unannounced annual inspection today. At approx 09:20 a.m. LPAs met with Executive Director (ED) Jeannette Ruggiero and explained the reason for the visit. At approximately 9:50 a.m., Licensing Program Analysts (LPAs), accompanied by the Executive Director, conducted an annual inspection of the facility’s physical plant, resident areas, common areas, grounds, food service, records, medications, infection control practices, emergency preparedness, and fire/life-safety systems. The inspection was conducted to assess compliance with applicable Title 22 regulations and health and safety requirements. The facility is an Independent Living section of a Continuing Care Retirement Community (CCRC). The community is gate-guarded and provides 24-hour security. The property includes four apartment buildings: Lakeview, Creekview, Mountainview, and Gardenview, as well as apartment condominiums and villas. The Clubhouse includes a commercial kitchen, dining rooms, activity rooms, business offices, and a library. Additional amenities include a fitness center, swimming pool, spa, and multiple outdoor common areas. Planned activities are provided, and the activity schedule is posted throughout the community. The dining room and commercial kitchen were inspected. Food service areas appeared clean and appropriately maintained. The facility maintained sufficient perishable and non-perishable food and water supplies to meet applicable minimum requirements. Refrigerators and food storage areas were checked for appropriate labeling and expiration dates. Food items observed had expiration dates clearly identified. An emergency food and water supply was stored in a designated storage room in the Lakeview building and was observed to be adequately stocked at the time of inspection. At approximately 10:05 a.m., LPAs observed residents participating in a group activity.

Desaree Perera
Brian Balisi
	DATE: 09/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: UNIVERSITY VILLAGE THOUSAND OAKS	FACILITY NUMBER: 565800978
	VISIT DATE: 09/29/2026

NARRATIVE

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LPAs inspected interior and exterior areas of the community. Common areas were clean and free of clutter or apparent hazards. Lighting was adequate, and furnishings appeared appropriate for resident use. Parking was available for residents and visitors. Passageways, walkways, driveways, steps, patios, and other means of egress were free of obstructions and apparent hazards at the time of inspection. Multiple outdoor areas were available for resident use and included shaded areas and seating. The swimming pool and spa were appropriately enclosed with self-closing/self-locking gates. The property also includes a pond and environmentally protected open space, including a riparian area. These areas are not fenced, but are surrounded by plants and other vegetation.

LPAs randomly selected resident rooms for inspection in the four main apartment buildings and villas. Rooms inspected were appropriately furnished and contained clean linens and appropriate furnishings. Bathrooms were adequately supplied with necessary personal care items and paper towels. Hot water temperatures measured in inspected resident areas ranged from 106.2°F to 114°F. Fire and life-safety equipment was observed throughout the inspected areas, including smoke alarms, carbon monoxide detectors, fire sprinklers, and fire extinguishers. Emergency evacuation plans/sketches were posted throughout the hallways. Emergency evacuation chairs and medical sleds were available in the stairways of each building. Several fire extinguishers were inspected and observed to be fully charged. Service records indicated a last service date of January 23, 2026. At approximately 11:45 a.m., LPAs observed residents exercising in a large activity room. Activity rooms and common areas appeared clean, adequately furnished, and in good repair. The facility’s most recent fire alarm inspection was completed in May 2026 and was reported to be in compliance with applicable fire code requirements. The fire sprinkler system was inspected on September 23, 2026. At the time of the inspection, the facility was awaiting the final inspection report and certification.

Required postings were observed throughout the property, including emergency exit information, the Licensing Complaint Poster, Resident Personal Rights, Theft and Loss Policy, and Resident Council Rights. Required notices were centrally posted in the mail room and in other appropriate areas throughout the community. Functioning telephones were available on the premises.

LPAs reviewed seven (7) resident records and seven (7) personnel records, including the current Executive Director’s personnel file.

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Brian Balisi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2026

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: UNIVERSITY VILLAGE THOUSAND OAKS	FACILITY NUMBER: 565800978
	VISIT DATE: 09/29/2026

NARRATIVE

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Continued from 809-C
Resident records were reviewed for, but not limited to, admission agreements, current medical assessments and TB results, Consent for Treatment forms, and current Needs and Services Plans. Personnel records were reviewed for, but not limited to, required personnel documentation, health assessments and TB results, criminal record clearances, First Aid/CPR certification, and required annual training. Records reviewed were complete and maintained as required at the time of inspection.

Medications are centrally stored in a secured medication room located on the lower level of the Clubhouse. LPAs observed that medications, including PRN medications, were labeled, stored, and secured in a manner that prevented unauthorized access by residents. Physician orders were available for PRN medications. Medication documentation, including centrally stored medication records and medication destruction records, was reviewed. Medication administration observed during the inspection was consistent with physician orders. The medication management process appeared adequate and in compliance with applicable Title 22 requirements at the time of inspection.

LPAs reviewed the facility’s infection control policies and emergency/disaster plan. The facility maintained written policies and procedures addressing infection control and emergency preparedness. Emergency/disaster supplies were maintained in four designated areas throughout the community. In addition, an emergency supply trailer was located in the overflow parking lot. LPAs observed cots, emergency food and water, a water pump, and other emergency supplies stored in the trailer.

The facility conducts emergency/disaster drills quarterly as required. The most recent disaster drill was conducted on August 27, 2026. Daily vehicle inspection records and the California Highway Patrol inspection report for facility vehicles were reviewed and appeared current and sufficient at the time of inspection.

Based on observations and records reviewed during the inspection, the facility was maintained in a clean and safe condition, and no immediate health or safety hazards were observed. No deficiencies or citations were issued during this inspection.

An exit interview was conducted with the Executive Director. The inspection findings were reviewed, and a copy of the report was provided to the facility representative.

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Brian Balisi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2026

LIC809 (FAS) - (06/04)

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