565850112-1-15-2021-29-AS-KLOZ-BXASA8-20210115124154

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565850112
Report Date: 01/15/2021
Date Signed: 01/15/2021 12:43:31 PM

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:	REGENCY PALMS OXNARD		FACILITY NUMBER:	565850112
ADMINISTRATOR:	GLASER, SUSAN		FACILITY TYPE:	740
ADDRESS:	1020 BISMARK LANE		TELEPHONE:	(805) 342-2001
CITY:	OXNARD	STATE: CA	ZIP CODE:	93033
CAPACITY:	127	CENSUS: 0	DATE:	01/15/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Ken Mahler		TIME COMPLETED:	11:13 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) KaSandra Lopez conducted a Pre-Licensing Inspection with Administrator Ken Mahler. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s visit was conducted virtually with the use of "FaceTime". An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL). A Fire Clearance was approved for a maximum capacity of 127 residents of which 15 may be non-ambulatory and 15 may be bedridden. Component III was conducted with the Administrator at the end of the physical plant inspection. The proposed facility is two story with all 101 resident apartments on the first floor only. The facility has a secured Memory Care unit with 30 apartments and Assisted Living apartments. There are nine locked courtyards on the facility grounds. On the second floor is a gymnasium for resident use, facility storage, and office space. A tour of the physical plant was conducted and the following observed: At 9:02 AM the virtual physical plant tour began in the entry of the facility. The LPA observed the screening station with PPE supplies and appropriate COVID-19 signs posted. The LPA also observed the Bistro, common area, reception area and activity calendar. At 9:06 AM the secured Memory Care unit was observed. The common areas and dining room areas were observed. There are three locked courtyards in the memory care unit which have delayed egress access. Rooms 187, 188, 192, and 197 were observed. The hot water temperature measured at 113.9, 116.4, 116.9, and 116.9 degrees F. Each bathroom was clean and sanitary with grab bars and non-skid mats. The signal systems and smoke alarms were tested in each room and were operational. The carbon monoxide detectors in the hallways were tested and were operational. The locked medication room was observed with locked medication cabinets, locked storage for resident records, and a first aid kit. Report continued on LIC 809-C.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 01/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2021

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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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: REGENCY PALMS OXNARD	FACILITY NUMBER: 565850112
	VISIT DATE: 01/15/2021

NARRATIVE

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At 9:35 AM the Assisted Living was observed. All the required postings are in the Administration area in front of the dining room. The administrator will add a copy of the CCL complaint poster in the entry way also.

At 9:38 AM the LPA observed the dining room area and kitchen. Both the dining room and kitchen were clean and sanitary. Cleaning supplies are stored separate from food supplies. The freezer was at 0 degrees F and the refrigerator was at 39 degrees F. There is a seven day supply of perishable food on site.

The LPA observed the emergency supply closet with extra linens and towels, emergency water and emergency lighting. The common areas in Assisted Living were observed including the theater room and activity room with activity supplies. The locked Assisted Living medication room was observed with locked storage for medications and resident records and first aid supplies. Apartments 102, 146, and 148 were observed. The hot water temperature measured at 114.6, 114.4, and 113.7 degrees F. The smoke alarms and signal systems were tested and operational. The fire extinguishers were last serviced on March 13, 2020. The carbon monoxide detectors in the hallways were tested and operational. There is a laundry room for resident use. Cleaning supplies are stored in the locked housekeeper's closet. The upstairs gymnasium and upstairs area was observed.

The facility has one bus for transportation use. There are no open bodies of water. The courtyards have shaded seating for resident use. A land line telephone and Ipads are available for resident use. The administrator's certificate expires 10/18/21.

The administrator will email the LPA a copy of the liability insurance. The administrator will also email the LPA the room numbers approved for non-ambulatory and bedridden use approved by the fire department.

No corrections are needed at this time.

This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating under the new license number until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.

Exit interview conducted and a copy of this report was provided to Mr. Mahler via email for signature.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 01/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2021

LIC809 (FAS) - (06/04)

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