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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850072
Report Date: 08/06/2021
Date Signed: 08/06/2021 09:55:32 AM

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:WILKIN, RONDAFACILITY TYPE:
740
ADDRESS:980 WARWICK AVETELEPHONE:
(805) 307-7300
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:82CENSUS: 33DATE:
08/06/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Ronda WilkinTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Ashley Smith arrived at 8am to meet with Executive Director Ronda Wilkin for a technical support visit with this community. In attendance included Public Health Nurse Amanda Ball from Ventura County Public Health. This visit had a specific emphasis on infection control practices.

This community has a central entry point for signing in, symptom screening, and temperature checks. The community has appropriate signs in the common spaces to promote mask-wearing and regular usage of hand sanitizer; recommendations were made around posting signage to promote physical distancing and proper hand hygiene. At this time, the community has stopped transportation, outdoor activities, and outside vendors from coming into the community. The current visitation protocol allows for scheduled visitation to take place outdoors, with a limited number of individuals per resident, with appropriate physical distancing. All staff and most residents were observed wearing masks throughout the common spaces. Hand sanitizer was available throughout the common spaces for resident and staff use.

During today's visit, discussion was had regarding testing, symptom screening, and adjusted procedures around visitation. The cleaning and disinfectant protocol is adequate; however, staff were reminded to observe the contact time needed for surfaces to be properly disinfected.The community is not experiencing any issues with staffing or obtaining Personal Protection Equipment (PPE) at this time. It was recommended to provide additional staff training pertaining to donning, doffing, and appropriate disinfecting of reusable Personal Protection Equipment.

No health and safety hazards noted during today's visit. Exit interview conducted. A copy of the report was provided.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
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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