565850169-10-19-2022-29-AS-KDUK-CKCRMA-20221019130824

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565850169
Report Date: 10/19/2022
Date Signed: 10/19/2022 01:10:02 PM

Document Has Been Signed on 10/19/2022 01:10 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 CAMARILLO		FACILITY NUMBER:	565850169
ADMINISTRATOR:	FAYE, SAM		FACILITY TYPE:	740
ADDRESS:	305 DAVENPORT STREET		TELEPHONE:	(805) 738-3600
CITY:	CAMARILLO	STATE: CA	ZIP CODE:	93012
CAPACITY:	150	CENSUS: 76	DATE:	10/19/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Bradlee Foerschner		TIME COMPLETED:	01:15 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 Analyst (LPA) Kelly Dulek arrived at the facility at 09:50AM for an unannounced annual inspection. This annual had a specific emphasis on infection control practices and procedures. Upon arrival, the LPA met with Executive Director Bradlee Foerschner. Entrance interview conducted. Beginning at 10:25AM, 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 11/12/2021. No safety concerns were noted at that time. Fire extinguishers throughout the building were observed to be fully charged and last serviced 09/09/2022. 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 Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

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: 10/19/2022

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
26
27
28
29
30
31
32

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 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 within the required range of 105 to 120 degrees Fahrenheit.

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.

The following recommendation was made:
- N95 fit testing for all staff

No deficiencies cited. Exit interview conducted with Executive Director Bradlee Foerschner. A copy of the report was provided via email.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3