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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801876
Report Date: 01/27/2023
Date Signed: 01/27/2023 02:32:39 PM


Document Has Been Signed on 01/27/2023 02:32 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:ATRIA GRAND OAKSFACILITY NUMBER:
565801876
ADMINISTRATOR:BRIAN LARIOSFACILITY TYPE:
740
ADDRESS:2177 E THOUSAND OAKS BLVDTELEPHONE:
(805) 370-5400
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91362
CAPACITY:140CENSUS: 118DATE:
01/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Brian LariosTIME COMPLETED:
02:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to conduct a required annual visit. The LPA met with Executive Director Brian Larios and informed them of the reason for the visit. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and community is in compliance with Title 22 Regulations.

Kitchen: At the time of the visit, there was a sufficient supply of two-day perishable and seven-day nonperishable food. The menu was posted, and the facility offers a daily specials and a standard selection at every meal. Appliances appeared to be in operable condition.

Common Areas: The facility is a three-story building, and it also has a basement level. There are resident rooms on all three floors, units are designated for assisted living residents on all three floors and a separate unit on the first floor is designated for residents in the memory care unit. There is a central entry point for universal screening and temperature checks. Staff were observed wearing appropriate face coverings throughout the visit. There was hands-free hand sanitizer interspersed throughout the common grounds.

There were no obstructions and/or tripping hazards observed. The facility maintains a comfortable temperature at 73 degrees Fahrenheit. The fire extinguishers were charged and last serviced 6/2022. Smoke detectors and carbon monoxide detectors are tested monthly and were operable at the time of the visit.

At the time of the visit, one elevator was in disrepair and was being repaired at the time of the visit. However, residents and staff have use of the second elevator.

Activities: Planned activities are offered, and the activity schedule was posted, and is provided to the residents on a weekly basis. Activity rooms and common spaces appeared clean and in good repair.

Rooms: The LPA toured randomly selected rooms in both the memory care and assisted living unit. Rooms appeared clean, well kept, and appropriately furnished.

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ATRIA GRAND OAKS
FACILITY NUMBER: 565801876
VISIT DATE: 01/27/2023
NARRATIVE
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Restrooms: Restrooms on all floors were clean and sanitary. Restrooms were fully stocked with supplies, and hand hygiene signs were observed in all restrooms. The water temperature was tested on all floors, including the basement level, and water temperature ranged from 111.6 -117 degrees Fahrenheit.

Outside areas: The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There was an enclosed patio for residents whom reside in the memory care unit. There was a locked pool with appropriate gating; however at 10:05 a.m., the LPA observed that the gate to the pool was open. The LPA informed staff. However, the LPA observed that the pool area was not locked upon notice, and was not closed as of 2:20 p.m. This is a zero tolerance violation; a civil penalty in the amount of $500 is assessed.

Infection Control: The community has an adequate supply of Personal Protection Equipment (PPE) and can obtain additional supplies. The community's cleaning protocol is sufficient. This facility has records of staff and resident vaccinations. The facility has previously managed COVID-19 active cases and the facility complied with all requirements set forth by the local health department and licensing. Staff are up to date regarding guidelines pertaining screening recommendations, masking requirements of staff and visitors, and reporting procedures. The community's policies and procedures pertaining to infection control were adequate.

The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. Civil penalties assessed. A copy of the report and appeal rights were provided.

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
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
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/27/2023 02:32 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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


FACILITY NAME: ATRIA GRAND OAKS

FACILITY NUMBER: 565801876

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 01/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87307(e)
Personal Accommodations and Services
(e) Facilities providing services to residents who have physical or mental disabilities shall assure the inaccessibility of fishponds, wading pools, hot tubs, swimming pools or similar bodies of water, when not in active use by residents, through fencing, covering or other means.

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, as the swimming pool was observed accessible to residents in care, which poses an immediate health and safety risk to persons in care.
POC Due Date: 01/28/2023
Plan of Correction
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The Administrator has agreed to do the following:
1. Secure the pool. Send out a memo to all staff, communicating protocol regarding pool usage and ensuring it is locked at all times. Inform CCL when this has taken place, but must take place no later than 1/28/2023, end of day.
Immediate civil penalty of $500 assessed.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:
DATE: 01/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/27/2023
LIC809 (FAS) - (06/04)
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