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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850112
Report Date: 01/31/2022
Date Signed: 01/31/2022 02:24:00 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 OXNARDFACILITY NUMBER:
565850112
ADMINISTRATOR:KENNETH MAHLERFACILITY TYPE:
740
ADDRESS:1020 BISMARK LANETELEPHONE:
(805) 247-0227
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:127CENSUS: 40DATE:
01/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:41 AM
MET WITH:Ken MahlerTIME COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced Required 1 Year inspection at the facility today. The LPA arrived at the facility at 10:41 AM and met with Administrator Ken Mahler and explained the reason for the inspection.

This annual had a specific emphasis on infection control practices and procedures. The LPA 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. The following was observed:

At 10:45 AM, the LPA began the physical plant tour in the memory care with the Administrator. The memory care is secured with delayed egress doors which lead to secured outdoor patios. The LPA observed one of the delayed egress doors to be functional. There are currently 21 residents residing in the memory care. The LPA observed apartment 194 at 10:52 AM. The room was furnished appropriately, the smoke detector was functional, and the hot water temperature measured at 111.2 degrees F. Each bathroom was clean and sanitary with grab bars and non-skid mats. The LPA also observed apartment 164 to be furnished appropriately, the smoke detector was functional, and the hot water temperature measured at 109.4 degrees F. The common dining area and common areas were also observed. The carbon monoxide detector in the common hallway was observed to be functional and the fire extinguisher observed were fully charged and last serviced in March 2021.

The LPA and Administrator toured the Assisted living part of the facility beginning at 11:07 AM. Four resident apartments were observed between 11:07 AM and 11:36 AM. All the apartments were furnished appropriately, had functioning smoke detectors, and the hot water temperature tested between 109.4 and 111.2 degrees F. Each bathroom was clean and sanitary with grab bars and non-skid mats. The common areas and activity room were observed. Carbon monoxide detectors in the common areas were tested and were operational. Fire extinguishers observed were fully charged and last serviced in March 2021. Report continued on LIC 809-C.

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2022
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: 01/31/2022
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The common areas open up to secured courtyards of which all assisted memory care residents have a key for exit and entry. Both the memory care and assisted living have secured medication rooms for medications and facility records. The second floor has no resident apartments but was observed to have a gymnasium for resident use, facility storage, and office space. The kitchen and assisted living dining room were observed. The dining room tables currently allow for only two residents at each table. The facility was observed to have a sufficient supply of perishable and non-perishable food.

During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening. LPA observed all staff to be wearing N95 masks. The LPA observed an adequate supply of Personal Protective Equipment (PPE) in a locked storage room along with extra linens and emergency water. The facility’s cleaning protocol is sufficient. Infection control signs were posted at the entry and throughout the facility and in the restrooms. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate.

No deficiencies cited. Exit interview and reported reviewed with the Administrator. A copy of the report was emailed.

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2022
LIC809 (FAS) - (06/04)
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