565800978-8-23-2022-29-AS-ASMH-CHKTR4-20220823145654

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565800978
Report Date: 08/23/2022
Date Signed: 08/23/2022 02:57:06 PM

Document Has Been Signed on 08/23/2022 02:57 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:	DMITRY ESTRIN		FACILITY TYPE:	741
ADDRESS:	3415 CAMPUS DRIVE		TELEPHONE:	(805) 241-3000
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	514	CENSUS: 473	DATE:	08/23/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Dmitry Estrin		TIME COMPLETED:	03:00 PM

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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 met with Executive Director Dmitry Estrin and explained the reason for the visit.

The LPA, along with the Executive Director, 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.

Common Grounds: 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. There is a central entry point at the gate for symptom screening and temperature checks. Staff were observed wearing appropriate face coverings. The LPA spoke with residents during the tour; residents appeared satisfied and voiced no concerns.

The Clubhouse has a commercial kitchen, the dining rooms, and various activity rooms. The community also has a fitness center and a theater. Planned activities are offered. Activity schedule is posted throughout the community. The LPA observed residents engaging in various group activities. All activity rooms and common spaces appeared clean and in good repair. There are fire extinguishers throughout the community, which were charged and last serviced 4/2022.

Kitchen: The facility had a sufficient supply of two-day perishable and seven-day nonperishable food at the time of the visit. The facility uses Sysco Foods for food delivery. The menu was posted and the facility offers an alternate menu. Snacks and beverages are available for residents.

Restrooms: Common restrooms were observed, and the LPA observed signs in the restrooms that promoted good hand hygiene. At 2:10 p.m., the hot water measured in the common restroom at 118.2 F. Restrooms were fully stocked with paper towels and soap.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022

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: UNIVERSITY VILLAGE THOUSAND OAKS	FACILITY NUMBER: 565800978
	VISIT DATE: 08/23/2022

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Exterior Grounds: The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. Parking is available for residents and visitors. The exterior and interior grounds were free of clutter and/or obstructions. The community has a swimming pool and a spa, both of which are appropriately fenced with self-locking gates. There is a pond, which is not fenced.

Infection Control: During today’s visit, the LPA spoke with the Executive Director regarding the community's infection control practices. Throughout the visit, the LPA observed signs in common areas that promoted guidance around COVID-19, appropriate masking, physical distancing, and the disinfection protocol. In addition, the LPA observed hand sanitizer interspersed throughout the common grounds. The community is not experiencing any issues with staffing or obtaining Personal Protection Equipment (PPE) at this time. Cleaning and disinfectant protocol is adequate. The community continues to monitor the vitals, symptomatic screening, and temperatures of the staff and visitors that come into the community. The Executive Director sends out updates pertinent to the community's infection control practices via mass voice messaging to the residents and next-of-kin. Staff are up to date regarding guidelines pertaining to visitation and vaccine requirements.

As residents that reside in this community are independent, should a confirmed case of COVID-19 arise, residents can be appropriately isolate in their apartments. Residents whom are on isolation precautions are provided with an isolation kit and are regularly monitored. The Infection Control plan and required updates were submitted timely. The facility has previously managed COVID-19 active cases and the facility complied with all requirements set forth by the local health department and licensing. 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: 08/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022

LIC809 (FAS) - (06/04)

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