567609944-2-9-2024-29-AS-KDUK-D2ASV6-20240209131214

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 567609944
Report Date: 02/09/2024
Date Signed: 02/09/2024 01:12:26 PM

Document Has Been Signed on 02/09/2024 01:12 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:	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:	02/09/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:36 AM
MET WITH:	Sharon Volner & Wendy McCain		TIME COMPLETED:	01:20 PM

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Licensing Program Analysts (LPAs) Valeria Conway and Kelly Dulek conducted an unannounced Annual Inspection at the facility today. LPAs arrived at 09:36AM and initially met with facility Program Director and Housing Manager. Entrance interview conducted. Shortly after the visit began, both Administrator Sharon Vollner and Director of Operations Wendy McCain arrived.

LPAs, along with facility Managers, toured the facility beginning at 09:44AM to ensure client health and safety and the facility is in compliance with Title 22 regulations. The following was observed:

Fire extinguishers observed throughout the facility were observed to be fully charged and last serviced 03/13/2023. Hardwired combination smoke and carbon monoxide detectors were tested at 11:40AM and were functional.

BEDROOMS: There are four (4) Bedrooms, three (3) of which are designated for shared client use. The fourth bedroom is located on the lower level and was previously designated as an isolation room, as needed for infection control purposes and is currently not being utilized. Two (2) shared bedrooms are located on the entry level and one (1) is located on the second story. All client bedrooms were observed to contain appropriate furniture, bedding and linens.

BATHROOMS: There are four (4) full bathrooms and one (1) half bath. Three (3) full baths are designated for client use and one (1) is designated as the isolation room bathroom. The half bath is designated for staff and guests. All bathrooms had functional fixtures and contained all required supplies. All bathrooms were supplied with appropriate paper and hygiene products. Water temperature was measured in all three (3) client restrooms and measured within the required range.

LAUNDRY: Laundry Room is located on the entry level. Laundry and cleaning supplies were observed to be inside a locked hall closet. Report Continued on LIC 809-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024

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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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: 02/09/2024

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COMMON AREAS: These included two (2) Living Rooms, the Dining area and an activity room. All common areas appeared to be clean and were appropriately furnished. Knives and other sharps are stored in a locked hall closet. There were no visible hazards.

TREATMENT/THERAPY & OFFICE AREAS: There is a group therapy room, an individual therapy room and an office designated for Staff use, which is used to store medications as well as first aid kit. The Offices are kept inaccessible to clients unless properly supervised.

KITCHEN: Appliances and fixtures appeared clean and functional. There was sufficient nonperishable food to accommodate clients for (seven) 7 days and perishable food for two (2) days. Management indicated lunch and dinner are catered and the clients eat out on the weekends. Clients prepare their own breakfast foods. There were no visible immediate hazards observed.

GARAGE: The garage is used as an activity room/gym as well as to store emergency food and water and additional supplies.

SURROUNDING GROUNDS: There is a front and back yard. The backyard is fenced with lawn and garden areas. The back yard has a patio with furniture appropriate for outdoor use and shade. There were no imminent or immediate visible hazards.

STAFF/CLIENT FILE REVIEW: LPA Dulek reviewed 5 (five) staff records during today's visit. LPA reviewed 5 (five) client file records during the visit. All staff and client records reviewed were in compliance with Title 22 regulation at the time of the visit.

INFECTION CONTROL/DISASTER PREPAREDNESS: During today’s visit, LPAs reviewed the facility's infection control policy and disaster preparedness policies. All items reviewed were in compliance. The facility conducts emergency disaster drills quarterly, with the most recent drill documented on 12/21/2023.

MEDICATION REVIEW: Beginning at 12:05PM, the LPAs reviewed medications for two (2) clients. All medications observed were documented and stored in compliance with regulation at this time.

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

No citations issued. Exit interview conducted. A copy of the report was provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024

LIC809 (FAS) - (06/04)

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