<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850607
Report Date: 11/15/2024
Date Signed: 11/15/2024 04:55:39 PM

Document Has Been Signed on 11/15/2024 04:55 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:PURE RECOVERY CALIFORNIAFACILITY NUMBER:
565850607
ADMINISTRATOR/
DIRECTOR:		CARMONA, CHRISTAFACILITY TYPE:
772
ADDRESS:741 MANDALAY BEACH RDTELEPHONE:
(805) 253-0080
CITY:OXNARDSTATE: CAZIP CODE:
93035
CAPACITY: 6CENSUS: 4DATE:
11/15/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:12 PM
MET WITH:Christa CarmonaTIME VISIT/
INSPECTION COMPLETED:
05:00 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 a Pre-Licensing Inspection with Applicant Representative/Administrator Christa Carmona. This application is a Change of Location application with clients in care. An Application to operate a Social Rehabilitation Facility (SRF) was received by Community Care Licensing (CCL) on 11/07/2024. Fire Clearance was approved for a maximum capacity of six (6) ambulatory clients on 11/13/2024.

The physical plant is a two (2) story single family dwelling located in a residential beach side neighborhood of Oxnard, CA. Beginning at 02:16PM, tour of the physical plant was conducted and the following observed:

GARAGE: Locked Garage was observed to be located on the entry level. The garage contains extra food, storage, chemical storage in a locked office area adjacent to the garage.

COMMON AREAS: These include the Living Room/Group Room and Dining Room. The common areas were furnished to accommodate a maximum capacity of six (6) clients. There were no immediate hazards observed. Fire extinguishers were observed throughout the facility; all were observed to be fully charged and last serviced 05/29/2024. Hardwired combination carbon monoxide/smoke detectors were tested and were functional. The facility laundry area is located on the second story.

TREATMENT/THERAPY, MEDICATION ROOM & OFFICE AREAS: The Living Room is also utilized as a group therapy room on the lower level. There is also a Nurse's Office/Medication Room on the second story. Medications are stored in a locked cabinet in the nurse's office, which contains adequate locked storage, as well as a locked refrigerator. A complete 1st Aid Kit is stored in the Medication Room.

KITCHEN: Appliances and fixtures appeared clean and functional. There was sufficient perishable and

Report Continued on LIC 809-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
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 2
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: PURE RECOVERY CALIFORNIA
FACILITY NUMBER: 565850607
VISIT DATE: 11/15/2024
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
non-perishable food supply as well as emergency food and water supply to accommodate a maximum capacity of 6 Clients. There was sufficient dining and cook ware to accommodate a maximum capacity of 6 Clients. Knives are stored locked.

BEDROOMS: There are 4 (four) Bedrooms, all of which are designated for client use. 1 (one) bedroom designated for private client use is located on the lower level. On the second story, there are 3 (three) bedrooms, 2 (two) of which are designated for shared client use and 1 (one) is designated for private client use. All bedrooms were equipped and supplied with appropriate furniture, bedding, linens, and adequate lighting.

BATHROOMS: There are 3 (three) total Bathrooms, 1 (one) on the lower level and 2 (two) on the second story. All bathrooms are designated for client use. Water temperature was measured in client bathrooms and measured within the required range of 105 degrees F to 120 degrees F at the time of the visit.

SURROUNDING GROUNDS: The Front Yard includes a driveway and walkway, which has direct beach access. The backyard has a patio equipped with furniture for client use. The patio also has a staircase, which leads to the beach access.

MEDICATION REVIEW: Beginning at 02:23PM, LPA reviewed medications for 2 (two) clients. Both clients' medications reviewed were documented and stored in compliance with regulation.

FILE REVIEW: Beginning at 03:00PM, LPA reviewed 4 (four) client files and 5 (five) staff files. All records were observed to be in compliance with regulation at the time of the visit.

INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan, both of which were observed complete and updated as required.

This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved.

Exit interview conducted. A copy of the Licensing Report was provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2