565801876-3-19-2025-29-AS-EPEI-DEWUWD-20250319155635

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565801876
Report Date: 03/19/2025
Date Signed: 03/19/2025 03:57:08 PM

Document Has Been Signed on 03/19/2025 03:57 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:	ATRIA GRAND OAKS		FACILITY NUMBER:	565801876
ADMINISTRATOR/ DIRECTOR:	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	TOTAL ENROLLED CHILDREN: 0	CENSUS: 125	DATE:	03/19/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:40 AM
MET WITH:	Eden Tolentino		TIME VISIT/ INSPECTION COMPLETED:	04:10 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) Emily Peraldi and Angela Barutyan arrived at the facility unannounced to conduct a required annual visit. At 9:50 a.m., the LPAs met with staff and explained the reason for the visit. At 10:15 a.m., the Executive Director (ED) Eden Tolentino arrived at the facility. At 10:26 a.m., the LPAs, along with the ED toured the physical plant areas inside and outside to ensure there are no health and safety hazards. The facility is a three-story building, with 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. KITCHEN: At 10:28 a.m., the LPAs observed the kitchen and dining area. Kitchen area remains inaccessible to residents. Knives are inaccessible to residents in care. Kitchen appliances are in operable condition. Chemicals and cleaning supplies were stored separately from the food and food preparation area. The facility has a sufficient supply perishable and nonperishable food. The menu was posted outside the dining area. Snacks and beverages are available for residents. BEDROOMS: The LPAs observed ten (10) randomly selected resident rooms throughout facility. Rooms were furnished with clean linens, appropriate furniture and sufficient lighting. RESTROOMS: The LPAs observed restrooms in ten (10) resident units and common area restrooms. All restrooms were fully stocked with supplies. Restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. Water temperature was tested throughout the visit and measured within the required range. Continued on LIC 809-C.

Kristin Heffernan	TELEPHONE: (818) 596-4493
Emily Peraldi	TELEPHONE: 818-421-4497
	DATE: 03/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025

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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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: 03/19/2025

NARRATIVE

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COMMON AREAS: The LPAs observed common area to be relatively clean and properly furnished. The LPAs observed the fire extinguishers throughout the facility to be fully charged and last serviced on 01/28/2025. The facility's smoke alarms are hard wired, and the facility is equipped with sprinkler system. Fire alarm/sprinkler system was last tested on 07/09/2024 with the Ventura County Fire Protection District. Inside temperature was maintained at a comfortable level.
OUTDOOR SPACE: The 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. No immediate concerns noted.
ACTIVITIES: Planned activities are offered, and the activity schedule was posted. The activity schedules are distributed to the residents and are also located near the elevators for residents to pick up if needed. Activity rooms and common spaces appeared clean and in good repair.
OTHER: Medications and first aid kits are located in locked medication rooms. There is also a mail room next to the receptionist area. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away in the janitor closets/maintenance closets. There are laundry rooms observed the second and third floor of the facility.

FILES: Between 1:40 p.m. and 3:22 p.m., the LPAs conducted a file review for nine (9) residents and six (6) staff. The nine (9) resident records were reviewed for, but not limited to: care plans, medical assessments, admissions agreement, consent forms. Resident records were in order. Six (6) personnel records were reviewed for, but not limited to: health assessments, first aid/CPR training, and training documentation. Personnel files were in order. Facility fire drill was last conducted on 02/26/2025. Emergency evacuation drill was last conducted on 02/27/2025. The LPAs reviewed facility's Infection Control Plan and Emergency and Disaster Plan which was observed to be complete and updated.
Starting at 2:05 p.m., the LPA conducted a review of medication and medication documentation with staff for three (3) residents and observed that medications were properly documented and assisted with as prescribed. No concerns or errors were observed.
During the physical plant tour, the LPAs conducted interviews with seven (7) residents and four (4) staff.
During the time of the visit, the LPAs obtained a copy of the liability insurance, resident roster and LIC 500 personnel report.

No deficiencies cited. Exit interview conducted. A copy of the report was provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025

LIC809 (FAS) - (06/04)

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