565800978-9-22-2023-29-AS-TCAA-CVWKNZ-20230922080359

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565800978
Report Date: 09/21/2023
Date Signed: 09/22/2023 08:04:17 AM

Document Has Been Signed on 09/22/2023 08:04 AM - 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:	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:	DATE:	09/21/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Dmitry Estrin		TIME COMPLETED:	05:15 PM

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Licensing Program Analysts (LPAs) Teresa Camara and Kelly Dulek arrived unannounced to conduct a required annual visit. LPAs met with Executive Director (ED) Dmitry Estrin and explained the reason for the visit.

At 9:46 a.m. LPAs along with the ED, 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. LPAs toured 9 independent living apartments and one villa at 12:50 p.m.

Common Grounds: This community is in 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. LPAs spoke with residents during the tour; residents were satisfied and voiced no concerns.

The Clubhouse has a commercial kitchen, dining rooms, activity rooms, business office, and library. The community also has a fitness center and a pool. Planned activities are offered. The activity schedule is posted throughout the community. LPAs 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 4/11/2023. Hot water was tested in several rooms and measured between 108*F - 114.6.*F. LPAs observed required postings located in the mailroom.

Kitchen: The facility had a sufficient supply of two-day perishable and seven-day nonperishable food and water at the time of the visit. The menu was posted and the facility offers an alternate menu. Continental breakfast, snacks and beverages are available for residents.

(continued on 9099-C)

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

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: UNIVERSITY VILLAGE THOUSAND OAKS	FACILITY NUMBER: 565800978
	VISIT DATE: 09/21/2023

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Restrooms: Common restrooms were observed, and the LPAs observed signs in the restrooms that promoted good hand hygiene. Restrooms were fully stocked with paper towels and soap.

Exterior Grounds: LPAs 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: LPAs spoke with the ED regarding the community's infection control practices. LPAs observed signs in common areas that promoted guidance around COVID-19. In addition, LPAs 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. As residents that reside in this community are independent, should a confirmed case of COVID-19 arise, residents can be appropriately isolated in their apartments. The community's policies and procedures as it pertains to infection control are adequate.

LPAs reviewed 10 resident files and 10 employee files which were complete. Medications appear to be given as prescribed.

No deficiencies observed. Exit interview conducted. A copy of the report provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

LIC809 (FAS) - (06/04)

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