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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801637
Report Date: 01/13/2025
Date Signed: 01/13/2025 12:49:10 PM

Document Has Been Signed on 01/13/2025 12:49 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:VETERANS HOME OF CALIFORNIA-VENTURAFACILITY NUMBER:
565801637
ADMINISTRATOR/
DIRECTOR:
CYNTHIA GAMBILLFACILITY TYPE:
740
ADDRESS:10900 TELEPHONE ROADTELEPHONE:
(805) 659-7501
CITY:VENTURASTATE: CAZIP CODE:
93004
CAPACITY: 60TOTAL ENROLLED CHILDREN: 0CENSUS: 56DATE:
01/13/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Cynthia GambillTIME VISIT/
INSPECTION COMPLETED:
12:55 PM
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Licensing Program Analyst (LPA) Teresa Camara conducted an unannounced case management visit regarding a self-reported incident on the relocation of three (3) residents from Veterans Home of California – West Los Angeles (License #197607966) to Veterans Home of California – Ventura (License #565801637) located at 10900 Telephone Road, Ventura, CA 93004 due to wildfire evacuation orders. LPA met with Administrator Cynthia Gambill and explained the reason for the visit.

During the visit, LPA conducted a health and safety check and no concerns were observed. The Administrator confirmed three residents have been temporarily relocated to Veterans Home of California – Ventura. At 11:38 LPA conducted a brief facility tour and met with two of the three residents evacuated to this facility. Resident 1 (R1) was taken to a local hospital this morning due to viral symptoms but is due back at the facility later today. Resident 2 (R2) shares a room with R1 and is quarantining, although R2 has no symptoms at this time. Resident 3 (R3) shares a room with another resident at this facility. Each room has a shared full bathroom. R1, R2 and R3 all self administer their medications. They each have a night stand to store their medications. Each of them have a bed with clean linens, room to store their belongings, and sufficient supplies of hygiene items. They are all non-ambulatory. The residents were all sent with records including the face sheet, physician's report, POLST, insurance cards, and medications lists.

At 11:55 a.m. LPA inspected the food supply which had a sufficient amount of two-day perishable and seven-day non-perishable food supplies.

LPA reviewed resident and staff rosters, the facility's Emergency Operations Plan, as well as the last fire inspection and fire system testing dated 12/17/2024.

No deficiencies observed. Exit interview conducted and report issued.
Desaree PereraTELEPHONE: (818) 593-4347
Teresa CamaraTELEPHONE: 818-326-4019
DATE: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2025
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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