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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802425
Report Date: 02/10/2023
Date Signed: 02/10/2023 03:49:58 PM


Document Has Been Signed on 02/10/2023 03:49 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:PACIFICA SENIOR LIVING OXNARDFACILITY NUMBER:
565802425
ADMINISTRATOR:KORTNIE SPITZNOGLEFACILITY TYPE:
740
ADDRESS:2211 E GONZALES RDTELEPHONE:
(805) 983-6808
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY:100CENSUS: 52DATE:
02/10/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Kortnie SpitznogleTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Ashley Smith conducted a Case-Management visit, with the aims of discussing the facility's infection control practices and procedures. This visit was conducted in conjunction with the local and state health department. In attendance included Jonte Vega and Olena Newell from Ventura County Public Health. All parties met with Executive Director Kortnie Spitznogle and Resident Services Director Tahania Gomez and explained the reason for the visit.

All parties 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 community continues to screen visitors upon entry into the facility. During the tour, recommendations were provided regarding disinfection practices, the availability of hand sanitizer, and additional staff training tools. The cleaning and disinfectant protocol was adequate; however, staff were reminded to observe the contact time needed for surfaces to be properly disinfected. Additional best practices were shared regarding cleaning tools and disinfectant agents used throughout the community.

During today's visit, parties discussed the recent outbreak and its impact that it had on visitation, communal dining, and communal activities. The community is not experiencing issues obtaining Personal Protection Equipment (PPE) at this time. The staff requested additional resources around obtaining COVID-19 tests and booster dosages for residents. It was recommended to provide additional staff training pertaining to donning, doffing, and disposal of PPE after usage. Staff were reminded to maintain voluntary compliance regarding reporting requirements to both local public health and the licensing department.

No immediate health and safety concerns noted during today’s visit. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2023
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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