565850168-10-24-2023-29-AS-JOLN-CWX47R-20231024185134

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565850168
Report Date: 10/24/2023
Date Signed: 10/24/2023 06:51:53 PM

Document Has Been Signed on 10/24/2023 06:51 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 RIVERPARK		FACILITY NUMBER:	565850168
ADMINISTRATOR:	CHRISTOPHER ANDERSEN		FACILITY TYPE:	740
ADDRESS:	901 TOWN CENTER DRIVE		TELEPHONE:	(805) 940-0390
CITY:	OXNARD	STATE: CA	ZIP CODE:	93036
CAPACITY:	140	CENSUS: 87	DATE:	10/24/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Chris Andersen, Administrator		TIME COMPLETED:	07:00 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 09:30 a.m. Licensing Program Analysts (LPA) Jenny Olson arrived at the facility unannounced to conduct a required annual visit. The LPA was greeted by staff and informed them of the reason for the visit. Administrator arrived shortly after. At 10:45 a.m. LPA conducted a tour of the physical plant with Administrator to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The following was noted: Facility is a double-story residence that consists of a memory care unit, and an assisted living unit. LPA observed fire extinguishers throughout the facility, which were fully charged and last serviced on 12/20/2022. The Administrator provided an annual fire alarm testing and inspection report done on 07/06/2023 and 10/09/2023 where all smoke alarms and carbon monoxide detectors were tested and functioned properly. LPA observed all required postings in the Activity Room near the entrance area. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. Kitchen: During the facility tour, the kitchen appeared clean and the appliances and fixtures functional. 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 in the dining area. Bedrooms: During today’s visit, LPA observed ten (10) randomly selected resident units. The 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. At 11:32 a.m. LPA observed Clorox wipes unlocked under the sink in Memory Care RM 114. The room was locked but the Clorox wipes were accessible to Resident 1 (R1). In assisted Living At 11:47 a.m. LPA observed Lysol Disinfectant spray, Clorox wipes, 409, and beach cleaner in RM139. The room was locked but accessible to Resident 2 and 3. At 11:55 a.m. Continued on LIC809-C.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

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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Document Has Been Signed on 10/24/2023 06:51 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: 10/24/2023

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 four out of ten locked resident rooms had disinfectants and or cleaning solutions available within those residents rooms, which poses an immediate health and safety risk to persons in care.
	POC Due Date: 10/25/2023
	Plan of Correction
1 2 3 4	Administrator immediately removed the items from the rooms and agreed to submit a plan to CCL on how they will ensure all rooms don't have disinfectants and cleaning solutions by 10/25/23.

Type A

Section Cited

CCR

87412(a)(13)(B)

Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: (B) Documentation of either a criminal record clearance or a criminal record exemption as required by Section 87355(e). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as one staff did not have a criminal record clearance, which poses an immediate health and safety risk to persons in care.
	POC Due Date: 10/24/2023
	Plan of Correction
1 2 3 4	Administrator immediately a took the 1 staff without criminal record clearance off the schedule. POC is cleared during the visit.

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: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

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: 10/24/2023

NARRATIVE

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The room was locked but accessible to R4. LPA observed disinfecting wipes and Lemon Lift Heavy Duty Kitchen and Bathroom cleaner with Bleach in RM222. At 12:07 pm LPA observed cleaning supplies in RM210. The room was locked but accessible to R5. Administrator immediately locked up R1’s Clorox Wipes with Memory Care Director and informed Assisted Living residents they would have to lock up their disinfectants and cleaning solutions with staff or give to their family members.
Bathrooms: The LPA observed all bathrooms, properly supplied and had functional fixtures. The LPA observed grab bars and non-skid shower floors in all bathrooms. Out of the ten (10) bathrooms observed, one (1) toilet and sink required cleaning. Upon observation, staff cleaned the areas. Water temperature measured in the restrooms ranged between 105.9 degrees Fahrenheit and 119.0 degrees Fahrenheit.

Common Areas: These included the beauty salon, library, activity room, theater, fitness center, bistro, and dining areas in assisted living and memory care units. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. Fireplaces were properly screened.

Surrounding Grounds (Outdoors): The LPA observed appropriate outdoor furniture, with a covered shaded area for residents in both, the memory care unit courtyard and the assisted living courtyard. Parking is available for residents and visitors.

Infection Control: The community's policies and procedures pertaining to infection control were adequate.

Record Review: A review of facility files was initiated. LPA Olson reviewed five (5) of ninety seven (97) Staff files. Out of the five files reviewed, LPA Olson identified one staff, (S1) did not have a criminal record clearance. LPA Olson reviewed five (5) out of eighty-seven (87) resident files. All files were complete.

MEDICATION AUDIT: A medication audit for three (3) of five (5) residents was initiated and the following was observed. The medications were stored in the medication carts, which was locked and inaccessible to the residents. During resident audits, the LPA observed various medications with the start date not properly documented on the centrally stored medication and destruction log. Staff documented the correct start date upon observation.

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, appeal rights and civil penalty was provided.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

LIC809 (FAS) - (06/04)

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