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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801019
Report Date: 02/21/2025
Date Signed: 02/24/2025 04:51:12 PM

Document Has Been Signed on 02/24/2025 04:51 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:MOUNTAIN VISTA OF OJAIFACILITY NUMBER:
565801019
ADMINISTRATOR/
DIRECTOR:		NICKIE PEREZFACILITY TYPE:
740
ADDRESS:602 EAST OAK STREETTELEPHONE:
(805) 646-6850
CITY:OJAISTATE: CAZIP CODE:
93023
CAPACITY: 38TOTAL ENROLLED CHILDREN: 0CENSUS: 26DATE:
02/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:32 PM
MET WITH:Nickie PerezTIME VISIT/
INSPECTION COMPLETED:
04:07 PM
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Licensing Program Analyst (LPA) Teresa Camara conducted a required annual inspection. LPA met with administrator Nickie Perez and explained the reason for the visit.

At 2:00 p.m., LPA along with the administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

KITCHEN: LPA inspected the main kitchen/food service area in building two. Kitchen appliances were clean and appeared in operable condition. The facility has a sufficient supply of perishable and non-perishable food and water. Refrigerator and dry food pantry were checked for proper labels and expiration dates and food labels had expiration dates clearly marked. Knives and sharps were observed locked and inaccessible in the kitchen; the kitchen door remains locked. LPA inspected the locked kitchen in building one where drinks and snacks are kept. The kitchen was clean and appliances appeared functional.

COMMON AREAS: The gathering rooms and dining rooms had appropriate furnishings that were in good condition. The facility maintained a comfortable temperature. At 2:45 p.m. the smoke detectors and carbon monoxide detectors were tested and operational at the time of the visit. The fire extinguishers were observed to be in compliance and last charged on 4/4/2024. LPA observed required postings throughout the common space. There is a working telephone on premises. Auditory alarms, call buttons and pendants were functioning at the time of the visit. LPA observed cameras in common areas.

(Continued on LIC 809C)

Desaree PereraTELEPHONE: (818) 593-4347
Teresa CamaraTELEPHONE: 818-326-4019
DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2025
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: MOUNTAIN VISTA OF OJAI
FACILITY NUMBER: 565801019
VISIT DATE: 02/21/2025
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Continued from LIC809

GARAGE: The garage is locked and detached. Most of the facilities food supplies, PPE, and personal care supplies are stored in the garage.

LAUNDRY ROOM: There is a washer and dryer in each building in a locked room. The staff assist residents with all laundry needs. Detergents and cleaning supplies were locked in a cabinet inaccessible to residents in care.

COURTYARD: The yard has a covered outdoor area with furniture for residents use. Emergency exits and passageways were observed free of obstruction. The facility has one (1) side gate that is delayed egress. The gate opened automatically when the fire system was tested as designed. No bodies of water noted at the time of the visit.

BEDROOMS: LPA inspected 10 resident bedrooms. All were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting.

RESTROOMS: LPA inspected restrooms and shower rooms. All were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper products.

LPA will return at a later date to review records and medications.

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

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025
LIC809 (FAS) - (06/04)
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