565801810-10-21-2023-31-AS-JGTN-CWTUV5-20231021155434

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565801810
Report Date: 10/21/2023
Date Signed: 10/21/2023 03:54:56 PM

Document Has Been Signed on 10/21/2023 03:54 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 S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	VENTURA TOWNEHOUSE		FACILITY NUMBER:	565801810
ADMINISTRATOR:	EVAN GRANUCCI		FACILITY TYPE:	740
ADDRESS:	4900 TELEGRAPH ROAD		TELEPHONE:	(805) 642-3263
CITY:	VENTURA	STATE: CA	ZIP CODE:	93003
CAPACITY:	566	CENSUS: 246	DATE:	10/21/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:32 AM
MET WITH:	Evan Granucci - Executive Director		TIME COMPLETED:	04:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPAs) Gary Tan and Michael Cava conducted an unannounced Required One (1) year inspection to this facility. LPAs initially met with staff Aman Thind and explained the purpose of the visit. Executive Director Evan Granucci arrived shortly. At 10:12 AM, with the assistance of the Executive Director, LPAs conducted a tour of the facility inside and out. There are two (2) main entrances being utilized at the facility, the main entrance at the front of the main building for visitors and residents and the opposite entrance being used by residents living in the villas. Screening area is located in the reception area which is in the middle of both entrances. Hand sanitizer and masks are available. The facility had submitted and approved Mitigation Plan and Infection Control Plan. Signs to wear a mask and other COVID-19 prevention protocol signs were posted outside the entrance door. Hand washing, coughing etiquette, physical distancing and other necessary signage were posted in the bathroom and all over the facility. The facility has a designated visitor's area in the main lobby of the building. The facility has a sufficient stock of PPE in the storage room. The facility consists of one (1) main building which houses independent and assisted living residents and seventy nine (79) private villas also house both assisted living and independent residents. The Memory Care has thirty (30) apartments in two (2) cottages which has its own building. The facility is fire cleared for five hundred sixty six (566) non-ambulatory residents, six (6) of which may be bedridden. The facility has a hospice waiver for twenty (20) residents. (continued to LIC 809-C)

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2023

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 S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: VENTURA TOWNEHOUSE	FACILITY NUMBER: 565801810
	VISIT DATE: 10/21/2023

NARRATIVE

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(continued from LIC 809)

The common areas such as the theater/activity room in the 7th floor, dining rooms on ground floor and memory care, gym and salon at the underground were clean, appropriately furnished and in proper order. Other common areas such as the billiard room and other activity areas were also observed to be appropriately furnished, clean and in proper order. Medication rooms on the ground floor was also inspected and observed to be clean and in proper order. The Kitchen was observed to be clean and have functioning appliances and fixtures. There are laundry rooms on 2nd, 4th and 6th floors to serve the residents.

The facility maintains a comfortable temperature at 75°F. The facility's smoke alarms are hard wired and interconnected and back up and tests are done in house on a quarterly basis, the last test was done on 08/29/23. The facility is equipped with sprinkler system which was last tested on 08/29/23 which is valid for five (5) years. Fire protection equipment performance report was last done on 08/29/23 valid for five years. Fire extinguishers are located all throughout the facility and were last serviced on 11/08/22. Fire Drill was last conducted on 08/12/23.

Personal accommodation in residents bedrooms and bathrooms were observed for safety, privacy, and comfort. Random resident rooms in the private villas, tower suites and memory care were inspected and observed with all required furnishings, working signal system, grab bars and nonskid surfaces in the bathrooms. Hot water temperature in random resident bathrooms were checked and measured at a range of 112.3°F to 118.9°F at the memory care, 117.4°F to 119.6°F at the tower villas and 109.4°F to 113.1°F at the private villas.

At 2:09 PM, LPAs reviewed records of thirteen (13) random residents and seven (7) staff. Resident and staff records were observed to be complete and updated.

Medications were observed to be in the medication cart in the Nurses' station. Medications were locked and inaccessible to residents. There were multiple complete first aid kits both in the cart and the medication room. Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2023

LIC809 (FAS) - (06/04)

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