565850112-1-4-2024-29-AS-ECOZ-CZ745F-20240104174752

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565850112
Report Date: 01/04/2024
Date Signed: 01/04/2024 05:48:43 PM

Document Has Been Signed on 01/04/2024 05:48 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:	REGENCY PALMS OXNARD		FACILITY NUMBER:	565850112
ADMINISTRATOR:	KENNETH MAHLER		FACILITY TYPE:	740
ADDRESS:	1020 BISMARK WAY		TELEPHONE:	(805) 247-0227
CITY:	OXNARD	STATE: CA	ZIP CODE:	93033
CAPACITY:	127	CENSUS: 79	DATE:	01/04/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Kenneth Mahler		TIME COMPLETED:	05:50 PM

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	At 09:15 a.m. Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit. The LPA was greeted by Administrator Ken Mahler and informed them of the reason for the visit. At 09:36 a.m. the LPA conducted a tour of the physical plant with Administrator Ken Mahler and Associate Administrator Gloria Morales to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: Facility is a double-story residence that consists of one (1) memory care unit (MC), and an assisted living unit (AL). The memory care unit is secured with delayed egress doors which lead to secured outdoor patios. The LPA observed one of the delayed egress doors to be functional. The second floor has no resident apartments but was observed to have a gymnasium for resident use, facility storage, and office space. The LPA observed fire extinguishers throughout the facility, which were fully charged and last serviced 03/27/2023. Smoke alarms and carbon monoxide detectors were tested and functioned properly. The LPA observed all required postings outside the Administrators office. Kitchen: During the facility tour at 9:38 a.m., the kitchen appeared clean and the appliances and fixtures functional during the time of visit. The LPA observed a sufficient amount of perishable and non-perishable food at the facility. Food is prepared based on the menu. Snacks and beverages are available for residents. Bedrooms: During today’s visit, the LPA observed ten (10) randomly selected resident units, of which four (4) were in memory care and six (6) in assisted living. Nine out of the ten resident bedrooms were properly furnished with at least one chair, nightstand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Report will continue on LIC809-C.

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

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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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: REGENCY PALMS OXNARD	FACILITY NUMBER: 565850112
	VISIT DATE: 01/04/2024

NARRATIVE

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Bedrooms continued: At 10:09 a.m. the LPA observed a bottle of over-the-counter 8HR Arthritis Pain Relief acetaminophen pills, a box of prescribed Aspercreme Lidocaine pain relief patches, a small tube of over the counter Maximum Strength Antibiotic Cream + pain relief, a tube of Biofreeze pain relieving gel, inside room# 195 in memory care. At 10:46 a.m. the LPA observed room 192 in memory care without a chair, and without a chest of drawers. Upon observation, the Associate Administrator stated rooms are furnished by the resident and/or their responsible party agreed on their admissions agreement. At 11:28 a.m. the LPA observed room 106 in AL to have a door that was not able to fully close, furthermore room #106 was observed to have prescribed and over the counter medication.
Bathrooms: The LPA observed all ten bathrooms in the randomly selected rooms clean and sanitary with grab bars and non-skid mats. Water temperature measured in the restrooms ranged between 113.0 degrees Fahrenheit and 118.0 degrees Fahrenheit.
Common Areas: These included the beauty salon, common areas and dining areas in assisted living and memory care. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. At 10:22 a.m. the LPA observed the laundry room in memory care unlocked with chemicals and cleaning supplies accessible to the residents. At 11:03 a.m. the LPA observed a laundry room in assisted living unlocked with chemicals and cleaning supplies accessible to the residents in care. The Administrator locked both laundry rooms upon observation. The facility maintained a comfortable temperature of 69 degrees. There were no obstructions and/or tripping hazards throughout the facility.
Surrounding Grounds (Outdoors): The LPA observed appropriate outdoor furniture, with umbrellas available for shade in all of memory care & assisted living courtyards. There were no bodies of water on the premises.
Interviews: During today’s visit, the LPA conducted five (5) resident and five (5) staff interviews. No concerns voiced during the interviews.
Record Review: At 02:25 p.m. a review of facility files was initiated. The LPA reviewed four (4) of seventy-nine (79) resident files. Out of the four files reviewed, LPA Cortez identified that one out of four residents (R1) require an updated appraisal needs and service plan, due to the diagnosis of dementia. The LPA identified that one out of four residents (R2) did not have a personal rights form LIC 613 or medical consent forms on file. Administrator stated files are online and will sent to the LPA.
Due to time constraints the LPA will return to complete the annual at a later date.
Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report and appeal rights provided.

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 01/04/2024 05:48 PM - It Cannot Be Edited

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: REGENCY PALMS OXNARD	FACILITY NUMBER: 565850112
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87309(a)

Storage Space

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. 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 as laundry rooms in both MC & AL were left unlocked with chemicals accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 01/08/2024
	Plan of Correction
1 2 3 4	Laundry rooms were locked during the inspection. The Administrator agrees to submit proof of staff training regarding regulation 87309 and submit proof to CCL by 01/08/2023.

Type A

Section Cited

CCR

87705(f)(2)

Care of Persons with Dementia

(f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. 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 as prescribed and over the counter medication was observed in residents rooms memory care which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 01/08/2024
	Plan of Correction
1 2 3 4	Items were secured upon observation. Administrator agreed to provide training regarding regulation 87705(f)(2). Submit sign in sheet no later than 1/08/2023.

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: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

LIC809 (FAS) - (06/04)

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