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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850112
Report Date: 01/28/2025
Date Signed: 01/28/2025 04:06:53 PM

Document Has Been Signed on 01/28/2025 04:06 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 OXNARDFACILITY NUMBER:
565850112
ADMINISTRATOR/
DIRECTOR:
KENNETH MAHLERFACILITY TYPE:
740
ADDRESS:1020 BISMARK WAYTELEPHONE:
(805) 247-0227
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY: 127TOTAL ENROLLED CHILDREN: 0CENSUS: 92DATE:
01/28/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Ken MahlerTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 9:30 a.m., the LPA met with Executive Director (ED) Ken Mahler and explained the reason for the visit.

RECORD REVIEW: Between 9:50 a.m. and 2:00 p.m., the LPA conducted a file review for nine (9) residents and eight (8) staff. Resident records were reviewed for, but not limited to: care plans, medical assessments, admissions agreement, consent forms. Resident records were in order. Personnel records were reviewed for, but not limited to: health assessments, criminal record clearances, first aid/CPR training, and training documentation showing required training completed. Personnel files were in order. Disaster drill was last conducted on 01/18/2025. Administrator certificate is current and valid until 10/18/2025. Documentation: During the time of the visit, the LPA obtained a copy of the liability insurance, resident roster, staff roster, Infection Control Plan and Emergency and Disaster Plan.

Starting at 2:15 p.m., the LPA conducted interviews with three (3) staff and the ED.

At 3:20 p.m., the LPA along with the ED conducted a brief physical plant tour to ensure there are no health and safety hazards.

Due to time constraints the LPA will return to complete the annual at a later date.

Exit interview conducted. A copy of the report was provided.
Kristin HeffernanTELEPHONE: (818) 596-4493
Emily PeraldiTELEPHONE: 818-421-4497
DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2025
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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