565802425-3-21-2025-29-AS-TCAA-DEYU3D-20250321151322

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565802425
Report Date: 03/21/2025
Date Signed: 03/21/2025 03:15:14 PM

Document Has Been Signed on 03/21/2025 03:15 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:	VISTAS AT OXNARD SENIOR LIVING,THE		FACILITY NUMBER:	565802425
ADMINISTRATOR/ DIRECTOR:	RICK OLDS		FACILITY TYPE:	740
ADDRESS:	2211 E GONZALES RD		TELEPHONE:	(805) 983-6808
CITY:	OXNARD	STATE: CA	ZIP CODE:	93036
CAPACITY: 100		CENSUS: 31	DATE:	03/21/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:02 AM
MET WITH:	Jovany Guerra		TIME VISIT/ INSPECTION COMPLETED:	03:30 PM

NARRATIVE

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Licensing Program Analysts (LPAs) Teresa Camara and Kelly Dulek arrived unannounced to conduct a required annual visit. LPAs met with Executive Director Jovany Guerra and explained the reason for the visit.

LPA Camara conducted the physical plant tour, medication review and interviews. LPA Dulek conducted the document review. LPAs ensured there were no health and safety hazards and community is in compliance with Title 22 Regulations.

At 9:28 a.m. LPA started the physical plant tour. The facility's fire suppression system was last inspected by the Oxnard Fire Department on 3/11/2024 and the inspection was satisfactory. The facility's smoke detectors and carbon monoxide detectors were last inspected by Boyd & Associates in December 2024. Fire extinguishers were last serviced on 7/9/2024 and appeared fully charged.

Kitchen: At the time of the visit, the kitchen was clean and appliances appeared operable. There was a sufficient supply of perishable and nonperishable food, properly stored. The menu was posted and copies are available for residents. The facility offers daily specials and a standard selection of alternatives at every meal. The kitchen staff have a binder with the special dietary needs of residents.

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 memory care residents. There were no obstructions or tripping hazards observed in the assisted living areas but there was a trip hazard observed in memory care outside of room 1204 where there was a hole in the floor poorly covered. The facility maintains a comfortable temperature. Both facility elevators were operating properly. There are four stairwells; all are equipped with emergency evacuation chairs. There is one delayed egress door on the west side of the memory care patio which was not functioning but the other delayed egress doors were operating properly.

(continued on LIC9099-C)

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025

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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Document Has Been Signed on 03/21/2025 03:15 PM - It Cannot Be Edited

Created By: Teresa Camara On 03/21/2025 at 02:37 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VISTAS AT OXNARD SENIOR LIVING,THE	FACILITY NUMBER: 565802425
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87303(a)

Maintenance and Operation

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above. The west side patio door on the memory care patio was not functional and there was a poorly covered hole in the floor in memory care which would cause a potential tripping hazard, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/28/2025
	Plan of Correction
1 2 3 4	Administrator has already set up arrangements to have the door repaired. He will send documentation to CCL of the door being repaired. Administrator will have the facility maintenance director repair the trip hazard on the floor and send a photo to CCL.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Desaree Perera

LICENSING EVALUATOR NAME:

Teresa Camara

LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025

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: VISTAS AT OXNARD SENIOR LIVING,THE	FACILITY NUMBER: 565802425
	VISIT DATE: 03/21/2025

NARRATIVE

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(continued from LIC9099)

Activities: Planned activities are offered and the activity schedule was posted. Activity room and common spaces appeared clean and in good repair.

Rooms: LPA toured ten randomly chosen resident rooms; two in memory care, three on the first floor in assisted living, three on the third floor and two on the second floor. Rooms appeared clean with sufficient lighting and appropriate furnishings.

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 117.1 - 118.2 degrees Fahrenheit.

Outside areas: LPA observed appropriate outdoor furniture for residents on both the memory care and assisted living patio areas. .

Records: LPA reviewed five resident files; all records found complete. LPA reviewed five staff files which appeared complete, including training records and CPR certifications.

Medications: LPA reviewed medications for randomly chosen residents; medications appeared to be given as prescribed.

Interviews: LPA interviewed six residents and three staff; there were no concerns noted.

The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in additional civil penalties.

Exit interview conducted. A copy of the report and appeal rights were provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025

LIC809 (FAS) - (06/04)

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