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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850168
Report Date: 10/27/2022
Date Signed: 10/27/2022 03:44:35 PM


Document Has Been Signed on 10/27/2022 03:44 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:OAKMONT OF RIVERPARKFACILITY NUMBER:
565850168
ADMINISTRATOR:ERIC MENSAHFACILITY TYPE:
740
ADDRESS:901 TOWN CENTER DRIVETELEPHONE:
(805) 940-0390
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY:140CENSUS: 86DATE:
10/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Chris Anderson, Executive DirectorTIME COMPLETED:
03:43 PM
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Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility at 10:10AM for an unannounced annual inspection. This annual had a specific emphasis on infection control practices and procedures. At 10:37AM, the LPA met with Executive Director (ED) Chris Andersen. Entrance interview conducted.

Beginning at 12:37PM, the LPA, along with facility Executive Director, 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:

Annual fire inspection was completed on 10/14/2022. No safety concerns were noted at that time. Fire extinguishers throughout the building were observed to be fully charged and last serviced 01/12/2022.



COMMON AREAS: The facility is a two story building. Facility has 2 working elevators and 3 stairwells. On the first floor, there are the kitchen facilities, dining room, Bistro, laundry rooms, medication room, bar/lounge area, library, activity rooms, formal sitting areas, beauty salon, fitness center, Wellness Center, office rooms, and common restrooms. On the second floor, there is a media room, laundry rooms, and common restrooms. The LPA observed fireplaces in the first floor dining area, library/reading room, the Bistro, and the formal sitting room, all were observed to be adequately screened at the time of the visit. The LPA observed common areas to be clean and in good condition. There were no obstructions and/or tripping hazards throughout the facility. Emergency exiting plans/sketch are posted throughout the facility. Other required postings were observed in the large activity room on the first floor.

The LPA and Executive Director toured the outside area of the facility. There are two outdoor gated courtyards: one is designated for Memory Care residents and the other one is designated for Assisted Living residents. The LPA observed appropriate outdoor furniture, with a covered shaded area for residents.
Report Continued on LIC 809-C
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly DulekTELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2022
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: OAKMONT OF RIVERPARK
FACILITY NUMBER: 565850168
VISIT DATE: 10/27/2022
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Continued from LIC 809
KITCHEN: The main kitchen and dining room are located on the 1st floor. Food is prepared in the main kitchen and delivered to the dining area and the Memory Care dining room. Facility dining room and commercial kitchen were inspected and found to be in compliance with Title 22 regulations. LPA observed sufficient perishable and non-perishable foods to meet the minimum three-day and seven-day emergency supply of food and water.

RESIDENT ROOMS: Memory Care is located on the first floor. The Memory Care Unit has all studio apartments with no appliances. Assisted Living units and can be found on the first and second floors of the building. Assisted Living units are either studio, one, or two bedroom units and rooms and are equipped with a refrigerator, sink, and microwave. All rooms in both the Memory Care and Assisted Living Units are complete, with properly installed grab-bars in resident bathrooms and non-skid surfaces in shower/tubs and sufficient furniture and bedding/linens. Water temperature was checked in randomly selected rooms in both the Assisted Living and Memory Care units. Water temperature was measured in Room 103's kitchen at 12:49PM and was 121.7 degrees Fahrenheit. Water temperature in room 248's kitchen measured at 123.8 degrees Fahrenheit at 1:03PM. In room 240's bathroom sink, water temperature measured at 124.4 degrees Fahrenheit at 01:17PM. At 01:24PM in room 132, which is in the Memory Care unit, the water temperature measured at 123.0 degrees Fahrenheit. The facility regularly logs water temperature readings for which the facility utilizes an infrared thermometer and an analog thermometer. The infrared thermometer measured the temperatures at a lower temperature than the LPA's digital thermometer and the facility's analog thermometer.

INFECTION CONTROL: During today’s visit, the LPA spoke with the Executive Director regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening. LPA observed all staff and visitors to be wearing masks. The LPA observed an adequate supply of Personal Protective Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. 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.


Report Continued on LIC 809-C
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly DulekTELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022
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: 10/27/2022
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Continued from LIC 809-C

RECORD REVIEW: During today's visit beginning at 11:50AM, LPA reviewed the Guardian background check system to ensure all staff are associated and background cleared. Interview revealed Staff #1 (S1) has been employed in the facility since 11/10/2021, has a background clearance, but was not associated to the facility.
The following recommendation was made:
- N95 fit testing for all staff

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Civil Penalties issued in the amount of $500. Executive Director was informed that failure to correct the deficiencies could result in additional civil penalties.

Exit interview conducted with Executive Director Chris Andersen. A copy of the report, civil penalties, and appeal rights were provided via email.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly DulekTELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 10/27/2022 03:44 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: OAKMONT OF RIVERPARK
FACILITY NUMBER: 565850168

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Request Denied
Type A
Section Cited
CCR
87303(e)(2)
Maintenance and Operation
(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 4 (four) of 10 (ten) water temperature readings taken throughout the building were above the required range reading at 121.7, 123.8, 124.4, and 123.0 degrees Fahrenheit, which poses an immediate safety risk to persons in care.
POC Due Date: 11/07/2022
Plan of Correction
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Executive Director contacted the Maintenance Department, who is adjusting the water temperature today. Water temperatures will be taken daily for a week, recorded on a log and sent to LPA by POC due date.
Type A
Section Cited
CCR
87355(e)(2)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above as Staff #1 (S1) has been employed and working in the facility since 11/10/2021 and S1's fingerprint clearance was not associated to the facility, which poses an immediate safety risk to persons in care.
POC Due Date: 10/27/2022
Plan of Correction
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During today's visit, Executive Director provided LPA with the transfer form and identification for S1 and LPA was able to transfer the employee's clearance in Guardian. POC cleared.
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: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly DulekTELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4