565850168-9-28-2024-29-AS-EMOY-D9JTC8-20240928143619

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565850168
Report Date: 09/28/2024
Date Signed: 09/28/2024 02:37:19 PM

Document Has Been Signed on 09/28/2024 02:37 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:	OAKMONT OF RIVERPARK		FACILITY NUMBER:	565850168
ADMINISTRATOR:	KAILEY VANDERWALL		FACILITY TYPE:	740
ADDRESS:	901 TOWN CENTER DRIVE		TELEPHONE:	(805) 940-0390
CITY:	OXNARD	STATE: CA	ZIP CODE:	93036
CAPACITY:	140	CENSUS: 88	DATE:	09/28/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Executive Director (ED) Kailey Vanderwall and Sales and Marketing Coordinator Lace Szelesteywoodfi		TIME COMPLETED:	02:50 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	Licensing Program Analysts (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit at 9:15 a.m. Upon arrival LPA were greeted by front door receptionist and explained the reason for the visit and to call their administrator. LPA met with Lace Szelesteywoodfi, Sales and Marketing Coordinator and Executive Director (ED) Kailey Vanderwall who arrived later during the visit. The reason for the visit was explained. At approx. 9:30a.m. LPA Mosley conducted a tour of the physical plant with Sales and Marketing Coordinator 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 12/19/2023. The Administrator provided a monthly fire alarm testing and inspection report done on 08/27/2024 where all smoke alarms and carbon monoxide detectors were tested and functioned properly. The last emergency disaster drill took place on 07/26/2024 and conducted quarterly. 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. Activities observed on both units. In the Memory Care until at approx. 9:30am, morning exercise was observed. In the Assisted Living unit at approx. 11:15am. painting was observed. Report Continued on LIC 809C...

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Erica Mosley	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2024

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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: OAKMONT OF RIVERPARK	FACILITY NUMBER: 565850168
	VISIT DATE: 09/28/2024

NARRATIVE

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Report Continued from LIC 809...
Kitchen: During the facility tour, at 9:56am 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. Knives are stored and inaccessible to residents. Refrigerator and food pantry were checked for proper labels and expiration dates.
Bedrooms: During today’s visit from approx. 10:01am to 10:45am, LPA observed eight (8) randomly selected resident bedrooms, of which five (5) in Assisted Living and three (3) in Memory Care. The resident bedrooms were properly furnished with at least one chair, night stand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets.
Restrooms: The resident restrooms appeared clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared in the private rooms. The hot water measured between 107.1 – 119.9 degrees Fahrenheit all within the required range.
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 / Emergency disaster planning: During today’s visit the LPA Mosley reviewed the facility’s infection control practices and the facilities emergency disaster plan. The facilities policies and procedures as it pertains to infection control are adequate.
Daily vehicle inspection list and California Highway Patrol Inspection report was reviewed for facility vehicles. All records were in order.
Report Continued on LIC 809C...

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Erica Mosley	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2024

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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: OAKMONT OF RIVERPARK	FACILITY NUMBER: 565850168
	VISIT DATE: 09/28/2024

NARRATIVE

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Report Continued from LIC 809...

Interviews: LPA conducted six (6) resident interviews from approx. 10:20am- 11:10am and six (6) staff interviews from approx. 11:15am- 11:40am.

MEDICATION AUDIT: There are two (2) medication rooms located on each side of the facility. Med Techs distribute medication at the appropriate times to residents in care. Medication audit for five (5) residents was conducted. Three (3) in the Assisted Living Unit and two (2) in the Memory Care Unit. The following was observed. The medications were stored in the medication room in carts, both were locked and inaccessible to the residents. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. No errors observed during review.

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

During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. LPA obtained the following documents - Resident roster, LIC 500, and copy of the Limited Liability insurance.

Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Erica Mosley	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2024

LIC809 (FAS) - (06/04)

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