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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800978
Report Date: 09/29/2025
Date Signed: 09/29/2025 02:52:49 PM

Document Has Been Signed on 09/29/2025 02:52 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:UNIVERSITY VILLAGE THOUSAND OAKSFACILITY NUMBER:
565800978
ADMINISTRATOR/
DIRECTOR:		DMITRY ESTRINFACILITY TYPE:
741
ADDRESS:3415 CAMPUS DRIVETELEPHONE:
(805) 241-3000
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY: 514CENSUS: 487DATE:
09/29/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Jeannette RuggieroTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analysts (LPAs), Brian Balisi and Martha Arroyo conducted an unannounced annual inspection today. At approx 09:45 a.m. LPAs met with  Executive Director (ED) Jeannette Ruggiero and explained the reason for the visit.
At approx 10:10am, the LPAs along with the Executive Director , 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. This community is in an Independent Living section of the Continuing Care Retirement Community (CCRC). The facility is a gate-guarded community with 24-hour security. There are 4 apartment buildings: Lakeview, Creekview, Mountainview and Gardenview, Apartment condos and Villas.
The Clubhouse has a commercial kitchen, dining rooms, activity rooms, business office, and library. The community also has a fitness center and a pool. Planned activities are offered. The activity schedule is posted throughout the community. During the visit LPAs observed residents engaging in various group activities. All activity rooms and common spaces appeared clean and in good repair. LPAs observed required postings centrally located in the mail room and throughout the property.
Facility dining room and commercial kitchen were inspected and found to be in compliance with Title 22 regulations. The LPAs observed sufficient perishable and non-perishable foods to meet the minimum two day and seven day supply of food and water.  Refrigerator and food pantry were checked for proper labels and expiration dates and food labels had expiration dates clearly marked. Emergency food supply was observed sufficiently stored in a storage room in the Lakeview apartment building. At approx 10:45 a.m. LPAs observed multiple residents exercising in the large activity room. Parking is available for residents and visitors. The exterior and interior grounds were free of clutter and/or obstructions. The community has a swimming pool and a spa, both of which are appropriately fenced with self-locking gates. There is a pond and environmentally protected land, which includes a riparian; both pond and open space are not fenced.
NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Brian Balisi
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: UNIVERSITY VILLAGE THOUSAND OAKS
FACILITY NUMBER: 565800978
VISIT DATE: 09/29/2025
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LPAs observed multiple resident rooms randomly chosen in the four (4) main buildings and Villas. All resident rooms were furnished appropriately, with clean linens and appropriate furnishings. The bathrooms were sufficiently stocked with supplies and paper towels.  Hot water temperatures were measured between 107– 115.5 degrees Fahrenheit.
The common areas were appropriately furnished, and the lighting was adequate. Smoke alarms, carbon monoxide detectors, sprinklers and fire extinguishers were observed throughout the facility.   The emergency exiting plans/sketch are posted throughout the hallways.  The facility has required postings, including emergency exit plan, Licensing Complaint Poster, Resident Personal Rights, Theft and Loss Policy, and Resident Council Rights.  There are functioning telephones on the premises.  Emergency evacuation chairs were present in all stairways in each building. There are  multiple large outdoor spaces with shaded areas and adequate furniture for resident use throughout the facility.  All passageways, walkways, driveways, steps and patios are free from obstructions and hazards at this time. Several fire extinguishers were observed  throughout the facility  to be fully charged and last serviced between 08/15/2025 to 09/05/2025.
LPAs reviewed ten (10) resident records and nine (9) personnel records. (10) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, Consent for Treatment form, and current needs and services plan. (9) personnel files including the current Executive Director’s file were reviewed for, but not limited to: personnel records, health assessments with TB results, criminal record clearances, first aid/CPR training, and the appropriate yearly training.  All files were observed to be in order during the visit. 
Medication review. The medications are centrally stored in a med rooms on the lower level of the clubhouse. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. PRNs have physicians order on file. Medications are properly documented on the centrally stored medications and destruction record. Medications appeared to be given as prescribed at the time of the visit.
During today’s visit, the LPAs reviewed the facility's infection control policy as well as their emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. The last fire alarm inspection  was completed on 12/29/2024 and was found to be in compliance with Fire Code Regulations at the time of inspections. Daily vehicle inspection list and California Highway Patrol Inspection report were reviewed for facility vehicles. The Fire Sprinkler system was inspected last week and facility is awaiting the report.  Emergency disaster drills conducted quarterly as per regulation; last disaster drill was conducted on 08/27/2025.

No citations issued. Exit interview conducted. Report was reviewed and copy provided.
NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Brian Balisi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2025
LIC809 (FAS) - (06/04)
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