Pre-licensing visit·July 2, 2021

Licensing Program Analyst (LPA) JoAnn Rosales conducted a Pre-licensing visit with Administrator Sam El-Rabaa. LPA spoke with applicant Ana De La Cerda - VP Regulatory Affairs over the telephone who designated the Administrator as the applicant representative. This application is a change of ownership from Aegis of Ventura #565800683. Component III was conducted in conjunction with this pre-licensing visit. LPA inspected facility for Fire Safety, Personal Accommodations and Services, Medication Procedures, and Food Service. First-aid kit is complete, facility has adequate linen, water and nonperishable food supplies. Facility has 2 shared and 33 private rooms in memory care floor 1, 5 private rooms in assisted living floor 1 and 44 private rooms in assisted living floor 2. All resident units have private bathrooms. Signal system was tested and operable. Hot water temperature tested at 112.1, 108.4, 112.9 and 109.6 degrees Fahrenheit in resident bathrooms. The common areas were appropriately furnished and lighting was adequate. There is additional entertainment equipment and games for activities. Resident records are kept in locked business and nursing offices. Staff records are kept in a locked business office. Resident medications are kept in locked medication room and locked medication carts. LPA observed smoke detectors and carbon monoxide detectors operating properly and fire extinguishers properly charged. Fire clearance is approved for 100 non-ambulatory residents of which 18 may be bedridden on the first floor. Bedridden is approved for first floor only. Bedridden rooms #100, 101, 102, 103, 104, 105, 106, 107, 109, 117, 118, 119, 120, 121, 122, 124, 126 and 127. Delayed egress and secured perimeter approved. During facility tour with Administrator at 11:23 am LPA observed a water fountain in the courtyard with water accessible to residents. Continued on 809-C During facility tour with Administrator at 11:30 am LPA observed furniture polish, stainless steel cleaner and polish, disinfectant spray, concentrated laundry destainer and laundry detergent in laundry room accessible to residents. During facility tour with Administrator at 12:03 pm LPA observed jock itch cream in resident #1 (R1)'s bathroom accessible to residents. R1's bedroom door was observed unlocked by LPA and Administrator. The physical plant is not in compliance with Title 22 regulations at this time. The following needs to be completed/proof submitted prior to the facility being licensed: 1. Deficiencies cited under existing facility Aegis of Ventura #565800683 cleared. Exit interview conducted, today's reports were reviewed and emailed to the Administrator.