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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801544
Report Date: 02/05/2025
Date Signed: 02/07/2025 10:24:01 AM

Document Has Been Signed on 02/07/2025 10:24 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:ARC OF VENTURA COUNTY - OXNARD, THEFACILITY NUMBER:
565801544
ADMINISTRATOR/
DIRECTOR:		JUAN GARCIAFACILITY TYPE:
775
ADDRESS:416 NORTH "A" STTELEPHONE:
(805) 240-1620
CITY:OXNARDSTATE: CAZIP CODE:
93030
CAPACITY: 90CENSUS: 60DATE:
02/05/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:Juan Garcia TIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Esther Cortez arrived at the Adult Day Program (ADP) unannounced to conduct a required annual visit at 10:40 a.m. The Facility is vendored by Tri-Counties Regional Center. The LPA met with Administrator Juan Garcia and explained the reason for the visit. The program currently operates from 9:00 a.m. to 4:15 p.m. on Mon./Wednes./Fri, and on Tues./Thurs. from 8:15 a.m. to 4:15 a.m.

At 11:00 a.m., the LPA and the Administrator toured the physical plant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations

Common Activity Space: The facility consist of several buildings for client and staff use surrounding the court yard area all listed building A through E. Buildings include administration building, laundry room, kitchen, dining room, activity rooms. There is an isolation room in building D for any sick clients to stay in until they can be taken home. The center outdoor patio has a covered area equipped with furniture for client use. There were no bodies of water noted. The program site appeared to be clean, safe, sanitary, and in good repair at this time. There was one carbon monoxide/smoke detector in each building which were tested and functioned properly during the visit. However, 10 rooms within the buildings did not have a smoke alarm. The facility has a fire suppression system. Throughout the tour the LPA observed the exit doors in buildings B and D locked, upon observation the Administrator unlocked them.

Activities: Activities are both designed for individual and as a group. Activity supplies were observed in all of the rooms. The LPA observed staff working with clients at the facility and other staff taking clients out into the community.

Report will continue on LIC809-C, 2nd page.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2025
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 3
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: ARC OF VENTURA COUNTY - OXNARD, THE
FACILITY NUMBER: 565801544
VISIT DATE: 02/05/2025
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Food Service: Clients bring their own lunches, and are provided a snack at the program. The kitchen is used for teaching purposes and only used under supervision with staff and clients. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. Hot water in the kitchen was measured at 147.2 F.

Restrooms: There are restrooms with stalls in building B and a single restroom in the administration building (building A). The restrooms were clean and sanitary. The hot water temperature in the restrooms in building B measured at 109.8F and the hot water in building A measured at 149.4 F.

Record Review: At 1:30 p.m. a review of facility files was initiated. The LPA observed documentation of Infection Control, Disaster prevention, and last fire drill (conducted on 12/26/2024). The LPA obtained Client and Staff Roster. The LPA reviewed five (5) staff files and five (5) client files. All documents reviewed appeared complete and current.



Infection Control: Facility has a sufficient supply of Personal Protection Equipment (PPE). The facility’s cleaning protocol was sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility's procedures as it pertains to infection control are adequate.

Interview: During today's visit, the LPA interviewed five (5) clients and two (2) staff. No immediate concerns voiced at this time.

Medication Audit: A medication audit for five (5) clients was initiated at 3:35 p.m. and the
following was observed. The medications are stored in a locked medication room and
inaccessible to the clients. All medications were properly documented on the centrally stored medication and destruction record (CSMDR).

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Exit interview conducted and copy of the report and appeal rights provided to Administrator.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/07/2025 10:24 AM - It Cannot Be Edited


Created By: Esther Cortez On 02/05/2025 at 04:31 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ARC OF VENTURA COUNTY - OXNARD, THE
FACILITY NUMBER: 565801544

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/05/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in two sinks as the hot water in one of the bathrooms measured at 149.9 F and the hot water in the kitchen measured at 147.2 F which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/06/2025
Plan of Correction
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Administrator agreed to adjust the water temperature and submit proof the hot water is within 105-120 F. Will submit proof to LPA by 2/6/2025.
Type A
Section Cited
CCR
82020
Fire Clearance
All day programs shall secure through the licensing agency and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 10 rooms that were observed without smoke detectors and 2 rooms that were locked which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/06/2025
Plan of Correction
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Administrator unlocked both rooms that were observed locked upon observation, agrees to install smoke detectors in all 10 rooms observe without them and will submit proof to LPA by 2/6/2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Kasandra Lopez
LICENSING EVALUATOR NAME:Esther Cortez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/05/2025


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