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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802425
Report Date: 02/15/2023
Date Signed: 02/15/2023 01:50:50 PM


Document Has Been Signed on 02/15/2023 01:50 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: 47DATE:
02/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Kortnie SpitznogleTIME COMPLETED:
02:00 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 Kortnie Spitznogle 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 LPA and Executive Director removed items that were perishable items past their expiration date (three pints of yogurt) and items that were not appropriately covered to eliminate concerns of cross-contamination. Staff were able to address this issue upon observation. Technical violation issued. The menu was posted for resident review. Appliances appeared to be in operable condition.

Common Areas: The facility is a three-story building. 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 was 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 fire extinguishers were charged and last serviced 7/2022. The facility received an annual report on 6/5/2022 in which smoke detectors and carbon monoxide detectors were checked and were in operable condition.

At 10:54 a.m., the LPA attempted to leave the enclosed courtyard in the memory care unit and discovered that the LPA was unable to egress back into the facility. The LPA had to wait for staff to open the door until they were able to get inside the main facility. There was also a resident whom was sitting in the courtyard, who would have been unable to get back into the facility unless staff opened the door. This is a personal rights violation.

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
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: PACIFICA SENIOR LIVING OXNARD
FACILITY NUMBER: 565802425
VISIT DATE: 02/15/2023
NARRATIVE
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Activities: Planned activities are offered, and the activity schedule was posted. 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.

Restrooms: Restrooms on all floors were clean and sanitary. Restrooms were fully stocked with supplies and paper towels. Water temperature was tested on all floors, and water temperature ranged from 113.2 -118.8 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 are fountains both in the assisted living and memory care patio, but the water was at an appropriate level where it didn’t create a hazard for residents in care.

Infection Control: The community has an adequate supply of Personal Protection Equipment (PPE) and can obtain additional supplies. The community's cleaning protocol was sufficient. This facility has records of staff and resident vaccinations. 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. 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: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 02/15/2023 01:50 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: PACIFICA SENIOR LIVING OXNARD

FACILITY NUMBER: 565802425

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 02/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87468.1(a)(6)
87468.1(a)(6) Personal Rights of Residents in All Facilities (a) Residents ... shall have all of the following personal rights:(6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interviews, the licensee did not comply with the section cited above, as the exterior doors to the courtyard in the memory care unit are locked from the inside, this inhibiting a resident from going back into the facility if they are in the courtyard, which poses an immediate personal rights risk to residents in care.
POC Due Date: 02/16/2023
Plan of Correction
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The ED agreed to do the following:
1. Address this with staff in an all-staff meeting, and discuss how the community will regain compliance with Regulation 87468.1(a)(6). Inform CCL when this has taken place, no later than 2/16/2023, end of day.
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: 02/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
LIC809 (FAS) - (06/04)
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