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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850072
Report Date: 03/29/2024
Date Signed: 03/29/2024 06:23:48 PM


Document Has Been Signed on 03/29/2024 06:23 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:SILVERADO THOUSAND OAKS, LLCFACILITY NUMBER:
565850072
ADMINISTRATOR:SABRINA PEGROSSFACILITY TYPE:
740
ADDRESS:980 WARWICK AVETELEPHONE:
(805) 307-7300
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:82CENSUS: 46DATE:
03/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Rob BabasantaTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Zabel Chochian conducted an unannounced required annual visit. Upon arrival the LPA met with Rob Bassanta the new Executive Director. Reason for LPA's visit was explained.

At approximately 1pm the LPA and the Executive Director toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.
COMMON SPACES: The facility is a two-story building. The kitchen, dining room, Bistro, laundry rooms, office spaces, and common restrooms are located on the first floor. The beauty salon, spa, Wellness Center, second dining, a private dining space, activity spaces, office spaces and common restrooms located on second floor. The LPA observed common areas to be clean and in good condition. There were no obstructions and/or tripping hazards throughout the facility. Cameras observed in the common areas, outdoor courtyard, and exterior perimeter. Required postings observed in the lobby and hallway area.
Fire extinguishers observed throughout the facility, which were serviced on 7/6/2023. Carbon monoxide detector tested and observed functioning. Facility smoke detectors are hardwired and tested. There are enclosed patio areas, one on the first floor and one on the second floor. LPA observed outdoor furniture, with a covered shaded area for residents use. There were no bodies of water observed during today’s visit. Delayed egress was tested on all exits and they were operational at the time of the visit.
KITCHEN: The main kitchen is located on the first floor. Facility dining room and commercial kitchen were inspected and found to be in compliance with Title 22 regulations. Facility food delivery takes place twice a week. There was a sufficient supply of perishable and non-perishable food. Food appeared to be of good quality. Carpet in the dining room observed to be stained. Executive director reported that the dining room carpet is frequently cleaned and is on schedule for cleaning in the next couple of days. BEDROOMS: The LPA observed a random selection of resident rooms, and rooms were furnished appropriately with clean linens, furnishings and sufficient lighting. RESTROOMS: The LPA observed a random selection of resident restrooms and all were observed clean, in operating condition with grab bars, and non-skid surfaces.
Due to time constraints, the annual inspection will be completed on a follow-up visit.
No health and safety hazards. Exit interview conducted. Copy of report provided.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel ChochianTELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:
DATE: 03/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/29/2024
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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