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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610183
Report Date: 10/30/2024
Date Signed: 10/30/2024 03:11:11 PM

Document Has Been Signed on 10/30/2024 03:11 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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:OAKMONT OF VALENCIAFACILITY NUMBER:
197610183
ADMINISTRATOR/
DIRECTOR:		MYLA BELSONFACILITY TYPE:
740
ADDRESS:24070 COPPER HILL DRIVETELEPHONE:
(661) 568-6080
CITY:VALENCIASTATE: CAZIP CODE:
91354
CAPACITY: 144CENSUS: 103DATE:
10/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Myla BelsonTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Tuesday Cabiness conducted an Annual Required visit and inspection of the facility. LPA met with an Executive Director and Myla Belson and explained the reason for the visit.

LPA toured the facility and observed the following: The facility is a large 2 story building with two (2) Memory Care Units (Tradition 1 and Tradition 2). In the main entrance of the building there is a cafe that is a self-serving refreshment and snack area with seating. The main living room has seating and a grand piano for entertainment. There is a reading room and private dining area for family or visitors to use.

Food Inspection: Kitchen and dining area are located on the ground floor of the facility. LPA observed there was sufficient stock of one week non-perishable foods and two days perishable food. Kitchen was observed to be sanitary and free of pests. And emergency food supply was stocked and locked in a storage room.

Smoke detectors/carbon monoxide are hardwired and located throughout the facility. Fire alarms are program to dispatch the Fire Department. During the inspection, the building and fire inspectors were at the facility, conducting service, and checking the operation of alarms. Fire extinguishers are located throughout the facility, and were charged. Evacuation drills are conducted twice a year, and the fire drill/disaster are done once a month on every shift.

Common Areas: Common areas consists of front lobby sitting area, activity rooms, in Assistance Living, and Memory Care Units. All areas were properly furnished and sanitary with sufficient room for residents to lounge. Facility also has a beauty salon, gym and a theater for residents. Laundry area is located on a the first and second floor of the facility. Facility has three (3) med-tech rooms, two (2) are located inside the Memory Care Unit and one (1) room is on an Assisted Living side. LPA observed all rooms were kept locked and inaccessible to residents in care.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE: DATE: 10/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2024
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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: OAKMONT OF VALENCIA
FACILITY NUMBER: 197610183
VISIT DATE: 10/30/2024
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Resident Rooms: Rooms consists of single or shared occupancy. A random selection of bedrooms was toured both in Memory Care and Assisted Living. All bedrooms were properly furnished and had appropriate furnishing. Rooms were observed to be sanitary.

Bathrooms: Bathrooms were toured and observed to be clean. Nonskid mats and grab bars were observed in all bathrooms. Hot water was measured and was in compliance according to licensing requirements. There is an emergency pull cord located by the toilet.

Due to time constraints, LPA was not able to complete the annual inspection. LPA will return to complete a full inspection and audit of resident, staff, and medication records.

Exit interview and copy of report provided.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024
LIC809 (FAS) - (06/04)
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