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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801637
Report Date: 01/27/2023
Date Signed: 02/02/2023 03:53:37 PM


Document Has Been Signed on 02/02/2023 03:53 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:VETERANS HOME OF CALIFORNIA-VENTURAFACILITY NUMBER:
565801637
ADMINISTRATOR:JULIAN BONDFACILITY TYPE:
740
ADDRESS:10900 TELEPHONE ROADTELEPHONE:
(805) 659-7515
CITY:VENTURASTATE: CAZIP CODE:
93004
CAPACITY:60CENSUS: 57DATE:
01/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Julian BondTIME COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced Required 1 Year Inspection at the facility today. The LPA met with Administrator Julian Bond and informed him of the reason for today's visit.

Beginning at 10:52 AM, the LPA along with the Administrator began the tour of the physical plant areas, inside and outside to ensure there are no health or safety hazards and facility is in compliance with Title 22 Regulations. Infection control practices were discussed with the Administrator and they are adequate. LPA inspected common areas including, but not limited to, the dining room, library, computer room, and activity rooms. LPA observed that the common areas were clean and fully functioning. Hand sanitizer stations were observed on the walls through out the facility. Fire extinguishers observed were fully charged and last serviced 03/22/2022. The carbon monoxide detector in the laundry room was tested an operational. Smoke detectors are serviced annually and quarterly. The last quarterly service was in December 2022 and the last annual service was in March 2022. Facility had a sufficient supply of Personal Protective Equipment and cleaning supplies. Medications and resident records are stored in the secured medication rooms.

The kitchen was observed which had a sufficient supply of perishable and non-perishable food and food was stored at the appropriate temperature. The facility has a sufficient supply of emergency water. Cleaning supplies and chemicals were stored separate from food storage areas.



Resident bedrooms have single or double occupancy with a shared restroom. Resident bedrooms observed were furnish appropriately. The call button located in one resident's bedroom was tested and was operational. Restrooms were clean and sanitary and in working condition. The hot water temperature measured in three resident rooms measured at 115.2 degrees F., 115 degrees F., and 114.1 degrees F.

No deficiencies were observed during the inspection. Exit interview conducted with the Administrator. A copy of the report was provided.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:
DATE: 01/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/27/2023
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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