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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850168
Report Date: 09/28/2021
Date Signed: 09/28/2021 05:25:04 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:OAKMONT OF RIVERPARKFACILITY NUMBER:
565850168
ADMINISTRATOR:BERGAN, KIMFACILITY TYPE:
740
ADDRESS:901 TOWN CENTER DRIVETELEPHONE:
(805) 940-0390
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY:140CENSUS: 87DATE:
09/28/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Kim BerganTIME COMPLETED:
05:23 PM
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Licensing Program Analyst (LPA) JoAnn Rosales made a Pre-licensing visit to the facility. LPA met with Administrator Kim Bergan. On 9/15/21 LPA received a letter from the Applicant Representative Susan McPherson designating Kim Bergan as the Applicant Representative for the Prelicensing visit. This application is a change of ownership from Oakmont of Riverpark #567609936. Component III was conducted in conjunction with this pre-licensing visit.

LPA inspected facility for Fire Safety, Personal Accommodations and Services, Medication Procedures, and Food Service. Facility has adequate linen, water and nonperishable food supplies.

Facility has 21 private and 6 shared rooms in memory care floor 1, 13 private rooms in assisted living floor 1 and 45 private rooms in assisted living floor 2. All resident units have private bathrooms. Signal system was tested and operable. The common areas were appropriately furnished and lighting was adequate. There is additional entertainment equipment and games for activities. The resident records will be kept in the locked medication rooms and business office. Staff records will be kept in a locked cabinet in the business directors office. Facility has locked medication rooms where resident medications will be kept. Hot water temperature tested at 105.2 degrees Fahrenheit in resident bathroom during today’s visit. LPA observed fire extinguishers properly charged. Administrator provided a copy of the Fire Alarm inspection report from 7/21/21 indicating that the Fire Alarms passed inspection. LPA observed carbon monoxide detectors operating properly. Fire clearance is approved for 140 non-ambulatory residents of which 8 may be bedridden in any apartment on any floor.

Continued on 809-C
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Joann RosalesTELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
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: OAKMONT OF RIVERPARK
FACILITY NUMBER: 565850168
VISIT DATE: 09/28/2021
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The following needs to be completed/proof submitted prior to the facility being licensed:

1. Current First Aid manual.

Exit interview conducted, today's report was reviewed and emailed to the Administrator.

SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Joann RosalesTELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
LIC809 (FAS) - (06/04)
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