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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850111
Report Date: 10/31/2025
Date Signed: 10/31/2025 04:19:48 PM

Document Has Been Signed on 10/31/2025 04:19 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:LEXINGTON ASSISTED LIVINGFACILITY NUMBER:
565850111
ADMINISTRATOR/
DIRECTOR:		SANJUANA JOANNA ENRIQUEZFACILITY TYPE:
740
ADDRESS:5440 RALSTON STTELEPHONE:
(805) 644-6710
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY: 125CENSUS: 63DATE:
10/31/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:46 AM
MET WITH:SanJuana Joanna EnriquezTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
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Licensing Program Analyst (LPA) Kelly Dulek conducted a required annual visit and discussed a recent self reported incident sent to Community Care Licensing on 10/28/2025 involving Staff #1 (S1) and Resident #1 (R1). LPA was greeted by the receptionist upon arrival. LPA met with the family liaison and wellness coordinator and explained the reason for the visit. LPA requested documents for review. Administrator SanJuana Joanna Enriquez arrived at 10:23AM. Entrance interview conducted.

At 11:04AM, LPA along with Administrator and family liaison 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. The following was noted:

The facility is a 3-story building, with common areas and resident rooms on all three (3) floors. The facility's memory care unit is located on the first floor and there are Assisted Living resident rooms on all three (3) floors.

BEDROOMS: LPA inspected ten (10) resident bedrooms, which were furnished appropriately with linens, appropriate furnishings, and sufficient lighting. LPA observed a sufficient supply of towels and linens.

RESTROOMS: The resident restrooms appeared clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared in the private rooms. Hot water temperature was measured in various rooms in both the memory care and assisted living units and ranged from 106.2 degrees to 110.2 degrees Fahrenheit, which is within the required range.

Report Continued on LIC 809C

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Kelly Dulek
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2025
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: LEXINGTON ASSISTED LIVING
FACILITY NUMBER: 565850111
VISIT DATE: 10/31/2025
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COMMON AREAS: Common areas include a theater, activity rooms, therapy room, game room, sweet shop, and dining room. Furniture in the common areas was observed to be in good condition. Carpet throughout the building was observed to be dirty and/or stained. Administrator stated the facility just purchased a carpet extractor, which will allow the facility to clean their carpets more thoroughly and regularly. The facility maintained a comfortable temperature throughout the visit. The fire extinguishers were fully charged and were last serviced May 6, 2025. LPA observed required postings throughout the common space. LPA observed the stairwells and they each had an emergency evacuation chair. Activity Rooms were observed and clean at the time of visit. The facility has an adequate supply of Personal Protection Equipment (PPE). The facility has a fenced in pool in the courtyard that has two locked gates. There was patio furniture and shade for residents.

KITCHEN: LPA inspected the kitchen/food service area, which is shared between this facility and the neighboring Skilled Nursing Facility. Knives are stored and inaccessible to residents. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food as well as an emergency supply of food and water kept in supply rooms on the third floor. Refrigerator and food pantry were checked for proper labels and expiration dates.

RECORDS: LPA reviewed five (5) resident records; all records were complete. LPA reviewed five (5) personnel records; all records were complete.

EMERGENCY DISASTER PLAN/INFECTION CONTROL PLAN: LPA reviewed the facility emergency disaster plan and infection control plan, both of which were complete and updated annually as required. The facility conducts monthly evacuation drills. Each month the drills are conducted during a different shift in order to meet quarterly training requirements.

MEDICATIONS: Due to time constraints, medications will be reviewed during the annual continuation visit.

DOCUMENTS OBTAINED: LPA obtained a copy of the facility's resident roster, personnel roster, and current liability insurance. LPA also reviewed and obtained copies of documents for R1 and S1 relevant to the self-reported incident.

INTERVIEWS: LPA interviewed three (3) residents and four (4) staff; no concerns were noted.

LPA will return at a later date to continue the annual inspection and to conduct further investigation into the self-reported incident. No citations issued. Exit interview conducted. A copy of today's report was provided.

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Kelly Dulek
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
LIC809 (FAS) - (06/04)
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