565850175-8-15-2024-29-AS-ABAN-D86T3J-20240815142225

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565850175
Report Date: 08/15/2024
Date Signed: 08/15/2024 02:22:39 PM

Document Has Been Signed on 08/15/2024 02:22 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:	LA VENTANA TREATMENT PROGRAMS		FACILITY NUMBER:	565850175
ADMINISTRATOR/ DIRECTOR:	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:	08/15/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:50 AM
MET WITH:	Bryce Colvard		TIME VISIT/ INSPECTION COMPLETED:	02:45 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 (LPAs) Angela Barutyan and Kelly Dulek conducted an unannounced required annual visit at the facility today. LPAs arrived at 10:50AM and initially met with Clinical Director Bryce Colvard. Administrator Sharon Volner and Licensee Steve Zamarripa were contacted and arrived during the facility tour at 11:05AM and 11:32AM respectively. Entrance interview conducted. A tour of the physical plant was conducted with the facility staff beginning at 10:56AM and the following was observed: Fire extinguishers were observed to be fully charged and last serviced on 02/16/2024. Hardwired combination smoke and carbon monoxide detectors were tested at 01:53PM 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 Monday-Friday for lunch and dinner preparation, and prepares or orders take-out on the weekends. Breakfast is prepared on site and snacks are available for clients. Sufficient perishable and nonperishable foods were observed. Report Continued on LIC 809-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024

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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Document Has Been Signed on 08/15/2024 02:22 PM - It Cannot Be Edited

Created By: Angela Barutyan On 08/15/2024 at 01:55 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: 08/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

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 in that three (3) client bathrooms had water temperatures measuring above the range at 136.7F, 142.5F, and 150.1F. This poses a potential health and safety risk to persons in care.
	POC Due Date: 08/23/2024
	Plan of Correction
1 2 3 4	Administrator contacted maintenance and lowered the water temperature during the time of the visit. Administrator will log water temperatures for three (3) times a day for seven (7) days and email to CCL by 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:

Angela Barutyan

LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024

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: LA VENTANA TREATMENT PROGRAMS	FACILITY NUMBER: 565850175
	VISIT DATE: 08/15/2024

NARRATIVE

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BEDROOMS: There are three (3) bedrooms designated for shared-client use. 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. All beds have a pendant signal system.

BATHROOMS: There are four (4) total bathrooms, of which three (3) are designated for client use and one (1) half bathroom in the hallway for staff use. Two (2) out of the three (3) client rooms have 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 temperatures measured at 142.5 degrees Fahrenheit at 11:07AM in the bathroom attached to bedroom #2, 150.1 degrees Fahrenheit at 11:09AM in the client hallway bathroom, and 136.7 degrees Fahrenheit at 11:13AM in the bathroom attached to bedroom #2, which is outside of the required range.

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.

MEDICATION REVIEW: The medications are stored in a locked closet in the facility entry way. Beginning at 11:20AM, LPAs reviewed medications for three (3) clients. All medications reviewed were stored and documented per regulation.

Report Continued on LIC 809-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024

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: LA VENTANA TREATMENT PROGRAMS	FACILITY NUMBER: 565850175
	VISIT DATE: 08/15/2024

NARRATIVE

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RECORD REVIEW: Beginning at 12:10PM, LPAs reviewed six (6) staff and five (5) client files for documents including but not limited to: client Admission Agreement, TB test, health screening, staff training and fingerprint clearance. All five (5) client files and six (6) staff records reviewed were in compliance with regulation at the time of the visit.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, LPAs 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 on 06/18/2024.

INTERVIEWS: During today's visit, LPAs 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 Clinical Director Bryce Colvard. Today’s reports and appeal rights were reviewed and provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024

LIC809 (FAS) - (06/04)

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