565850175-8-26-2023-29-AS-KDUK-CV3U9W-20230826152348

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565850175
Report Date: 08/26/2023
Date Signed: 08/26/2023 03:25:02 PM

Document Has Been Signed on 08/26/2023 03:25 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:	LA VENTANA TREATMENT PROGRAMS		FACILITY NUMBER:	565850175
ADMINISTRATOR:	VOLNER, SHARON		FACILITY TYPE:	772
ADDRESS:	965 RANCHO ROAD		TELEPHONE:	(818) 584-5615
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91362
CAPACITY: 6		CENSUS: 4	DATE:	08/26/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Sharon Volmer & Wendy McCain		TIME COMPLETED:	03:30 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 conducted an unannounced Annual Inspection at the facility today. LPA arrived at 12:17PM and initially met with facility staff Rachel Zamfir. Administrator Sharon Volner and Director of Operations Wendy McCain were contacted and arrived during the facility tour. Entrance interview conducted. A tour of the physical plant was conducted with the facility staff beginning at 12:19PM and the following observed: Fire extinguishers were observed to be fully charged and last serviced on 12/13/2022. Hardwired combination smoke and carbon monoxide detectors were tested at 01:43PM and were functional at the time of the visit. GARAGE AND GROUNDS: The garage is accessible from the house but is designated as the Recreation Room. Personal hygiene items (shampoos, soaps) and toxic items stored locked and inaccessible the garage. There are additional linens and towels in the garage cabinets. Emergency food and water is stored in the garage cabinets. The exterior passageways were clean and clear of any obstructions. There is a covered patio area in the backyard with tables and chairs where clients can sit. There is a locked storage shed in the backyard. There is a cascading water feature in the backyard; however the water level does not pose a safety hazard to clients in care. KITCHEN: Appliances and fixtures appeared clean and functional. The facility is utilizing a catering company for lunch and dinner preparation Monday-Friday, and eat out on the weekends. Breakfast is prepared on site and snacks are available for clients. Sufficient perishable and nonperishable food was observed. Report Continued on LIC 809-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2023

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 08/26/2023 03:25 PM - It Cannot Be Edited

Created By: Kelly Dulek On 08/26/2023 at 02:22 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LA VENTANA TREATMENT PROGRAMS	FACILITY NUMBER: 565850175
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

81088(e)(1)

Fixtures, Furniture, Equipment, and Supplies

(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). 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 water temperature in three (3) of three (3) client restrooms measured above the required temperature, with measurements at 134.8, 134.6, and 140.2 degrees Fahrenheit which poses an immediate safety risk to persons in care.
	POC Due Date: 09/05/2023
	Plan of Correction
1 2 3 4	Water temperature was turned down immediately. Facility managment agreed to record water temperatures daily for a 7-day period, measured at various times of the day, and submit a copy of the water temperature record to CCL by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Heffernan

LICENSING EVALUATOR NAME:

Kelly Dulek

LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2023

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: LA VENTANA TREATMENT PROGRAMS	FACILITY NUMBER: 565850175
	VISIT DATE: 08/26/2023

NARRATIVE

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BEDROOMS: The facility utilizes three (3) bedrooms as client bedrooms. All rooms are set up with beds, night stands, lamps, chests of drawers and closet space. Lighting in the rooms appeared adequate. Client Room #2 has a direct exit to the outside. Client Room #1 has a fireplace, which is adequately screened.

BATHROOMS: There are four (4) total bathrooms, three (3) of which are designated for client use; the half bathroom in the hallway is a designated for staff. Two out of the three client rooms has an attached bathroom, and the other client full bathroom is in the hallway. The client tubs are equipped with nonskid surfaces. Grab bars were observed in the bathrooms. Temperature was measured in all three (3) client bathrooms. Water temperature measured at 134.8 degrees Fahrenheit at 12:28PM in the bathroom attached to bedroom #1. Water temperature measured at 134.6 degrees Fahrenheit at 12:34PM in the bathroom attached to bedroom #2. Water temperature measured at 140.2 degrees Fahrenheit at 12:42PM in the client hallway bathroom.

COMMON AREAS: The common areas were appropriately furnished, and the lighting was adequate. Emergency exiting plans/sketch are posted throughout the facility. Emergency telephone numbers are posted in the kitchen. Other required postings are posted in the hallway upon entry into the facility.

TREATMENT/THERAPY & OFFICE AREAS: There is an Isolation Room, a Group/Zen Room, and a Staff Room. Group and individual therapy takes place in the Recreational Room, Group Room, Living Room, and the outdoor space. Staff files are kept in the main office, however training records remain on site. Client files are stored electronically and physically in the staff room.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, LPA reviewed the facility's infection control policy as well as the emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. The facility conducts monthly emergency disaster drills, with the most recent completed in June 2023.

RECORD REVIEW: Beginning at 01:00PM, LPA reviewed staff and client files for but not limited to: client Admission Agreement, TB test, health screening, staff training and fingerprint clearance. All four (4) client files and staff records reviewed were in compliance with regulation at the time of the visit.
Report Continued on LIC 809-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2023

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: LA VENTANA TREATMENT PROGRAMS	FACILITY NUMBER: 565850175
	VISIT DATE: 08/26/2023

NARRATIVE

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MEDICATION REVIEW: The medications are stored in a locked closet in the facility entry way. Beginning at 01:47PM, LPA reviewed medications for all four (4) clients. All medications reviewed were stored and documented per regulation.

INTERVIEWS: During today's visit, LPA interviewed two (2) staff and two (2) clients.

Pursuant to Title 22 Division 6 Chapter 2 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D): Exit interview conducted with Administrator Sharon Volner and Director of Operations Wendy McCain. Today’s reports and appeal rights were reviewed and provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2023

LIC809 (FAS) - (06/04)

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