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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 567609954
Report Date: 07/26/2023
Date Signed: 07/26/2023 04:29:39 PM


Document Has Been Signed on 07/26/2023 04:29 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:ARTESIAN OF OJAI, THEFACILITY NUMBER:
567609954
ADMINISTRATOR:MICHAEL O'NEILLFACILITY TYPE:
740
ADDRESS:203 E EL ROBLAR DRIVETELEPHONE:
(805) 798-9305
CITY:OJAISTATE: CAZIP CODE:
93023
CAPACITY:72CENSUS: 41DATE:
07/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Michael O'NeillTIME COMPLETED:
04:45 PM
NARRATIVE
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Licensing Program Analysts (LPAs) KaSandra Lopez and Martha Arroyo arrived at the facility unannounced to conduct a required annual visit at 10:00 a.m. Upon arrival, the LPAs met with Administrator, Michael O’Neill and the reason for the visit was explained. Entrance interview conducted.

The LPAs toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. There are four (4) resident buildings in total. Two (2) Assisted Living (Maricopa and Sespe) and two (2) Memory Care (Topa Topa and Matilija). The following was noted:

KITCHEN: Each building has their own kitchen and dining area. The LPAs inspected the kitchen/food service area at Maricopa Building at 10:20 a.m. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 10:31 a.m., the LPAs observed the knives and sharps drawer unlocked and staff was unable to locate key to lock drawer. Refrigerator and food pantry were checked for proper labels and expiration dates. The LPAs inspected the kitchen/food service area at Sespe Building at 10:50 a.m. At 10:51 a.m., the LPAs observed a pair of scissors in an unlocked drawer. At 10:52 a.m., the LPAs observed items unlocked under the sink that included: Waxie Green glass & surface cleaner and Waxie Green all-purpose cleaners. Staff immediately locked cabinet. The LPAs inspected the kitchen/food service area at Topa Topa Memory Care Building at 11:11 a.m. At 11:26 a.m., the LPAs observed a knife on the kitchen counter accessible to residents in care. Staff immediately locked knife at the time of visit.

COMMON AREAS: At the time of the visit, furniture in the common areas were observed to be in good condition. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detectors tested were operational at the time of the visit. The fire extinguishers were fully charged and were last serviced 07/19/2023. The LPAs observed required postings throughout the common space. The last fire-drill took place on 05/18/2023. Fireplaces were observed adequately screened. Report continued on LIC 809-C.

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2023
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 07/26/2023 04:29 PM - It Cannot Be Edited

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: ARTESIAN OF OJAI, THE
FACILITY NUMBER: 567609954

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87202(a)
Fire Clearance
(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above as the facility does not have an approved fire clearance for delayed egress and the facility is currently using delayed egress in two buildings which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/26/2023
Plan of Correction
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The Administrator agrees to submit an updated LIC 200, facility sketch, and LIC 9054 to CCL so an updated fire clearance can be obtained. Civil penalties will continue to accrue until this documentation is received.
Type A
Section Cited
CCR
87303(e)(2)
Maintenance and Operation
(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in one out of twelve resident rooms tested for hot water had a hot water temperature over 120 degrees F (121.6 degrees F in apartment 414) which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/02/2023
Plan of Correction
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The Administrator shall submit proof of a five day water temperature log indicating the hot water in apartment 414 is within the required range. Proof shall be submitted by 08/02/2023.
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: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/26/2023 04:29 PM - It Cannot Be Edited

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: ARTESIAN OF OJAI, THE
FACILITY NUMBER: 567609954

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87309(a)
Storage Space
(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above as knives and scissors were in an unlocked drawer, Waxie Green glass & surface cleaner and Waxie Green all-purpose cleaners were observed in an unlocked cabinet and medications and sharp items in an unlocked resident room which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/02/2023
Plan of Correction
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The items were secured during the inspection. The Administrator agrees to submit proof of staff training regarding regulation 87309 and submit proof to CCL by 08/02/2023.
Type A
Section Cited
CCR
87465(a)(4)(a)
87465(a)(4)(a) A plan for incidental medical and dental care shall be developed by each facility… (4) The licensee shall assist residents with self-administered medications as needed.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above as three out of four resident medications reviewed had errors which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/02/2023
Plan of Correction
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The Administrator agrees to submit proof of staff medication to CCL by 08/02/2023.
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: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2023
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: ARTESIAN OF OJAI, THE
FACILITY NUMBER: 567609954
VISIT DATE: 07/26/2023
NARRATIVE
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At 11:11 a.m., the LPAs observed Memory Care building Topa Topa to have egress doors. The Matilija building also has delayed egress. Upon review of facility’s file, the facility did not have an approved fire clearance to have delayed egress doors at time of inspection. The Fire Safety Inspection request on file dated 07/02/2020 indicates delayed egress was not approved. At 12:28 p.m., the LPA’s observed an adequate supply of emergency water.

BEDROOMS: The LPAs observed random resident bedrooms, which were furnished appropriately with linens, appropriate furnishings, and sufficient lighting. The LPAs observed a sufficient supply of towels and linens. At 10:21 a.m. the LPAs observed Room #102 in the Maricopa Building to be open unlocked. The LPA’s observed a pair of scissors and medications on the counter unlocked and accessible to other residents in care. At 10:39 a.m., the LPAs pulled emergency cord; however, the system did not alert staff as the iPad and iPhone were not logged into the system. The Administrator logged both electronics into the system at the time of visit.

RESTROOMS: The resident restrooms appeared clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared in the private rooms. The hot water temperature was measured in three (3) random bathrooms in each of the four (4) buildings. Random bathrooms in the Maricopa building were tested between 10:22 a.m. and 10:30 a.m., the temperature measured between 115.5 – 114.8 degrees Fahrenheit. Random bathrooms in the Sespe building were tested between 10:39 a.m. and 10:59 a.m., the temperature measured between 111.7 – 114.4 degrees Fahrenheit. Random bathrooms in the Topa Topa building were tested between 11:15 a.m. and 11:27 a.m., the temperature measured between 119.6 – 121.6 degrees Fahrenheit. Random bathrooms in the Matilija building were tested between 12:08 p.m. and 12:23 p.m., the temperature measured between 117.6 – 119.3 degrees Fahrenheit. The Administrator had maintenance staff adjust the water at the time of visit.

Report continued on LIC 809-C.

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
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: ARTESIAN OF OJAI, THE
FACILITY NUMBER: 567609954
VISIT DATE: 07/26/2023
NARRATIVE
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MEDICATIONS: Medications review began at 11:30 a.m. The medications are centrally stored in each building. Medications are labeled and checked for expiration dates. At 11:34 a.m. Resident #1's (R1) centrally stored medication and destruction record was observed to not have the start dates listed for their medications. At 11:48 a.m., LPAs observed Resident #2 (R2) had all medication popped for the 27th and staff could not explain why an additional day was popped. At 11:53 a.m., the LPAs observed Resident #3's (R3) cycle fill medication cards that were supposed to have been started on 07/01/2023 and there are six pills left and there should only be five pills left. Staff also could not explain how this happened.

During today’s inspection, the LPAs received a copy of the resident roster, staff roster, liability insurance, emergency disaster plan, and the last fire drill conducted.

Due to time constraints the LPAs will return to complete the annual at a later date.

The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties.

Civil Penalties assessed today in the amount of $500 due to the fire clearance violation. Exit interview and report reviewed with the Administrator. A copy of the report and appeal rights were provided.

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 07/26/2023 04:29 PM - It Cannot Be Edited

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: ARTESIAN OF OJAI, THE
FACILITY NUMBER: 567609954

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(I)(B)

87303 Maintenance and Operation
Facilities shall have signal systems which shall meet the following criteria:
(1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall: (B)Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff. This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above as the iPod and iPod used to receive notification of pull cord request from a resident apartment was not on to alert staff which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/26/2023
Plan of Correction
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The issue was corrected during the inspection. Plan of correction cleared.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2023
LIC809 (FAS) - (06/04)
Page: 6 of 6