565850112-11-29-2022-29-AS-KLOZ-CLN4CP-20221129175930

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565850112
Report Date: 11/29/2022
Date Signed: 11/29/2022 06:01:33 PM

Document Has Been Signed on 11/29/2022 06:01 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
CCLD Regional Office, 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 LANE		TELEPHONE:	(805) 247-0227
CITY:	OXNARD	STATE: CA	ZIP CODE:	93033
CAPACITY:	127	CENSUS: 56	DATE:	11/29/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:57 AM
MET WITH:	Ken Mahler		TIME COMPLETED:	04:43 PM

NARRATIVE

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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced Required 1 Year inspection at the facility today. The LPA met with Administrator Ken Mahler at 12:01 PM 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 12:12 PM, 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 two of the delayed egress doors to be functional. There are currently 24 residents residing in the memory care. The LPA observed apartments 182, 173, 165 in the memory care between 12:19 PM and 12:32 PM. Smoke alarms were tested and operational, hot measured between 115.7 degrees F and 116.7 degrees F, and apartments were furnished appropriately. The carbon monoxide detector in a common hall way was observed to be functional and fire extinguishers observed were last serviced on 03/11/2022.

The kitchen and emergency food supply was observed beginning at 12:45 PM. The LPA observed a sufficient supply of perishable and non-perishable food, although the LPA observed expired food items in the emergency food supply and in the two day perishable and seven day non-perishable food supply. Expired items observed were removed during the inspection, which included Cream of Wheat with a best by date of 08/27/2022, scalloped potatoes with a best by date of 11/03/2021, coconut milk with a best by date of 10/31/2022, yogurt (on the back of a top shelf) with a best by date of 8/10/2022 and lemonade on the back of a top shelf with a best by date of February 2022. Food was observed to be stored at appropriate temperatures.

Report continued on LIC 809-C.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

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: 11/29/2022

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The common areas open up to secured courtyards. Both the memory care and assisted living have secured medication rooms for medications and facility records. The second floor has no resident apartments. The LPA observed assisted living apartments 200, 103, 109, 149, 139, and 143. The hot water temperature in the resident bathrooms measured between 105 degrees F and 118.1 degrees F and smoke alarms tested were operational. The signal system was also tested and is operational.

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.

The following deficiency was observed and cited from the CA Code of Regulations (See LIC 809-D) Exit interview and reported reviewed with the Administrator. A copy of the report and appeal rights was emailed.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/29/2022 06:01 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: REGENCY PALMS OXNARD	FACILITY NUMBER: 565850112
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Deficiency Dismissed

Type A

Section Cited

CCR

87555(b)(8)

87555 General Food Service Requirements (b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. 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 the facility had food with past best by dates which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 11/30/2022
	Plan of Correction
1 2 3 4	The expired food items observed were removed during the inspection. The Administrator agreed to submit a written memo of understanding that The Director of Dining Services will go through the entire food supply today and remove any expired items and also submit an additional food order tomorrow and the food will arrive by Friday. The written of memo shall be submitted by 11/30/2022.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

LIC809 (FAS) - (06/04)

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