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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850169
Report Date: 10/18/2023
Date Signed: 10/18/2023 01:56:45 PM


Document Has Been Signed on 10/18/2023 01:56 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 CAMARILLOFACILITY NUMBER:
565850169
ADMINISTRATOR:FOERSCHNER, BRADLEEFACILITY TYPE:
740
ADDRESS:305 DAVENPORT STREETTELEPHONE:
(805) 738-3600
CITY:CAMARILLOSTATE: CAZIP CODE:
93012
CAPACITY:150CENSUS: 77DATE:
10/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Bradlee FoerschnerTIME COMPLETED:
02:00 PM
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Licensing Program Analysts (LPAs) Teresa Camara and Kelly Dulek arrived at the facility at 09:40AM for an unannounced annual inspection. Upon arrival, the LPAs met with Executive Director (ED) Bradlee Foerschner. Entrance interview conducted.

Beginning at 10:20AM, LPA Camara, 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 11/04/2022 and pull stations were inspected on 05/24/2023. No safety concerns were noted at that time. Fire extinguishers throughout the building were observed to be fully charged and last serviced 12/20/2022.



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. 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. 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.

OUTDOOR SPACE: LPA Camara and ED 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. 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: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2023
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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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 CAMARILLO
FACILITY NUMBER: 565850169
VISIT DATE: 10/18/2023
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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/RESTROOMS: Memory Care is located on the first floor and has 36 rooms. Out of the 36 rooms, 4 are identified for double occupancy. The Memory Care Unit has all studio apartments with no appliances. There are 54 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 and measured between 107 to 117.6 degrees Fahrenheit, within the required range.

RECORD REVIEW: LPA Dulek reviewed records beginning at 10:40AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. All five (5) staff files and five (5) resident files observed were in compliance with regulation.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA Dulek reviewed the facility's Infection Control Plan and the Emergency Disaster Plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency Disaster Plan was observed to be complete and updated annually as required. Last emergency disaster drill was conducted on 09/12/2023.

MEDICATION REVIEW: LPA Camara reviewed medications for three (3) residents during today's visit. All medications observed were labeled, stored, and properly documented at the time of the visit.



INTERVIEWS: During today's visit, LPA Camara interviewed four (4) staff and four (4) residents.

No citations issued. Exit interview conducted. A copy of today's report was provided.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly DulekTELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2023
LIC809 (FAS) - (06/04)
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