565801876-3-21-2024-29-AS-TCAA-D3KLXM-20240321090857

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565801876
Report Date: 03/20/2024
Date Signed: 03/21/2024 09:09:27 AM

Document Has Been Signed on 03/21/2024 09:09 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:	ATRIA GRAND OAKS		FACILITY NUMBER:	565801876
ADMINISTRATOR:	BRIAN LARIOS		FACILITY TYPE:	740
ADDRESS:	2177 E THOUSAND OAKS BLVD		TELEPHONE:	(805) 370-5400
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91362
CAPACITY:	140	CENSUS: 109	DATE:	03/20/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Brian Larios		TIME COMPLETED:	04:55 PM

NARRATIVE

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Licensing Program Analysts (LPAs) Teresa Camara and Martha Arroyo arrived unannounced to conduct a required annual visit. LPAs met with Executive Director Brian Larios and explained the reason for the visit.

LPAs 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.

The facility has a comprehensive disaster plan. The facility conducts a full evacuation of the facility annually and conduct monthly fire drills. The facility uses Johnson Controls to inspect their fire suppression system with the last inspections being conducted in August 2023 and January 2024. The facility maintenance staff conducts monthly inspections of all smoke and carbon monoxide detectors with the last inspection being conducted on March 2024.

Kitchen: At the time of the visit, there was a sufficient supply of perishable and nonperishable food. The facility also has an emergency supply of food and water. The menu was posted and copies are available near the elevators for residents to take. The facility offers 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 memory care residents.

There were no obstructions and/or tripping hazards observed. The facility maintains a comfortable temperature. The rooms have separate thermostats so residents can adjust the temperature to their preference. The fire extinguishers were charged and last serviced January 2024. Both facility elevators were operating properly. There are three stairwells that all have emergency evacuation chairs.

(continued on 809-C)

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ATRIA GRAND OAKS	FACILITY NUMBER: 565801876
	VISIT DATE: 03/20/2024

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(continued from LIC809)

Activities: Planned activities are offered and the activity schedule was posted. The activity schedules are distributed to the residents and they are also located near the elevators for residents to pick up if they need another copy. Activity rooms and common spaces appeared clean and in good repair.

Rooms: LPAs toured ten randomly chosen rooms; two in memory care, four on the second floor and four on the third floor. Rooms appeared clean, well kept, with sufficient lighting and appropriately furnished.

Restrooms: Restrooms on all floors were clean and sanitary. Restrooms were fully stocked with supplies. The hot water temperature was tested on all floors and ranged from 112.8 -117.6 degrees Fahrenheit.

Outside areas: LPAs 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 area with appropriate gating.

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. The community's infection control plan is adequate.

Records: LPAs reviewed ten resident files and ten staff files starting at 2:15 p.m.; all were complete. Medications were reviewed at 3:50 p.m. and appeared to be given as prescribed.

Interviews: LPAs interviewed five residents and four staff; no concerns were noted.

No deficiencies cited. Exit interview conducted and report issued to ED.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

LIC809 (FAS) - (06/04)

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