567609944-2-1-2022-29-AS-ASMH-CB8PE2-20220201101424

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 567609944
Report Date: 02/01/2022
Date Signed: 02/01/2022 10:14:59 AM

Document Has Been Signed on 02/01/2022 10:14 AM - 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:	567609944
ADMINISTRATOR:	KLEIN, DIAHANN		FACILITY TYPE:	772
ADDRESS:	2479 LA GRANADA DRIVE		TELEPHONE:	(805) 371-1274
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91362
CAPACITY: 6		CENSUS: 5	DATE:	02/01/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Sharon Volner and Wendy McCain		TIME COMPLETED:	10:20 AM

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) Ashley Smith arrived at the facility unannounced at 9:00 a.m. to conduct a required one year/post-licensing annual inspection. The LPA met with the Director of Nursing Wendy McCain and Administrator Sharon Volner and explained the reason for the visit. The LPA toured the facility inside and outside with staff ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: Kitchen knives are stored locked and inaccessible in the closet in the hallway. Appliances in the kitchen were clean and all appeared functional. The facility has a sufficient supply of perishable and non-perishable food. At 9:17 a.m., the hot water in the kitchen registered at 120.6 degrees Fahrenheit. Cleaning supplies are kept locked in a hallway closet. BEDROOMS: The facility has designated three shared bedrooms for clients. All rooms are set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. Lighting in the rooms was adequate. BATHROOMS: There are four full bathrooms and one-half bath. The half bath is designated for staff use only. Two out of the three client rooms have an attached bathroom. Bathrooms were stocked with supplies and paper towels. The showers and bathtubs are equipped with nonskid surfaces and/or mats. COMMON AREA: The common areas were appropriately furnished, and the lighting was adequate. There is a television and other entertainment equipment in the living room area. There is a fireplace in the living room but was observed without any tools. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detector were tested at 9:24 a.m. and were operational at the time of the visit. The fire extinguishers were fully charged and serviced 3/1/2021.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022

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: LA VENTANA TREATMENT PROGRAMS	FACILITY NUMBER: 567609944
	VISIT DATE: 02/01/2022

NARRATIVE

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LAUNDRY: The laundry area is in a separate room. Laundry detergent is stored inaccessible.

MEDICATIONS: Medications are kept locked and inaccessible in a closet in the staff room.

RECORDS: Records records review began at 9:28 a.m.; clients records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Staff schedules and lists were compared to the Guardian Caregiver Background Check system; all staff were associated at the time of the visit.

THERAPY AND STAFF: The facility is equipped with an Isolation Room and Recreational room on the ground/basement floor, a Group/Activity Rooms, and a Staff Room on the first floor, and a small therapy room on the second floor. The above-mentioned rooms can be utilized for individual and group therapy. Client files are stored electronically, however the facility also has physical client files. Staff files are stored in a centralized location.

GARAGE AND GROUNDS: 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 were no imminent or immediate hazards noted.

INFECTION CONTROL: The facility has a central entry point for symptom screening and sanitation station for staff, clients and visitors. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. Staff are up to date regarding guidelines pertaining to visitation and vaccine requirements. The LPA observed signs throughout the space that promoted good hand hygiene, signs and symptoms of COVID-19, droplet precautions, and proper mask usage. The facility’s policies and procedures as it pertains to infection control are adequate.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022

LIC809 (FAS) - (06/04)

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