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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801979
Report Date: 09/23/2023
Date Signed: 09/23/2023 02:18:04 PM


Document Has Been Signed on 09/23/2023 02:18 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:WELLNESS CARE SENIOR LIVINGFACILITY NUMBER:
565801979
ADMINISTRATOR:MARIA HERNANDEZFACILITY TYPE:
740
ADDRESS:158 ROCKAWAY ROADTELEPHONE:
(805) 649-5143
CITY:OAK VIEWSTATE: CAZIP CODE:
93022
CAPACITY:56CENSUS: 27DATE:
09/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:39 AM
MET WITH:Administrator / Maria Hernandez TIME COMPLETED:
12:20 PM
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At 10:00am on 09/23/2023, Licensing Program Analyst (LPA) Jeffries arrived unannounced at the facility to conduct the annual facility inspection. LPA met with Administrator, Maria Hernandez announced who he was and the reason for the visit.

Administrator and LPA conducted a cursory tour of the facility. LPA toured and observed 4 bed, 2 bathroom unit on the east side wing of the facility. LPA observed lights to be in good working order, bedding to have regulation appropriate linin, storage and drawers to meet regulation requirements. Bathrooms in the 4 bedroom unit had nonskid mats, paper towel dispenser and liquid soap for resident use. 4 bedroom units all have a front and back entrance and exits. There are working fire extinguisher placed throughout the facility and near each 4 bedroom unit. This facility has 4 building wings, the east, south and west wings are resident units. There are a total of 37 resident rooms, 19 bathrooms, a living room in the west resident room building. The main building (north) has and office, break room, laundry room, kitchen, large dining room, larger family room and large living room for residents. There is a clinic in the north building where medication is stored and locked, as well as resident files. There is an outdoor quad in the middle of the facility that has tables and shade for residents to be outside. There are 5 delayed egress gates at the north side of the facility, 3 are main entrance ways and two are side exit gates. LPA observed the facility to be clean and in good repair. LPA observed battery operated smoke detectors in the rooms toured and in the main north building. LPA observed all doorways to be free and clear of passage. LPA conducted staff interviews of all staff working during this inspection. Due to time constraints LPA will have to return at a later date to finish this annual inspection.

Exit interview, report read, and report provided.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:
DATE: 09/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2023
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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