Facility Evaluation Report

Licensing Program Analyst (LPA) Elsie Campos arrived at the facility announced at 12:40 p.m. to conduct a

pre-licensing inspection. LPA met with Administrator Connie Roush. This is a change of ownership application from Colony of Thousand Oaks at Greendield, Inc. (#565850257) to Colony of Thousand Oaks at Greenfield, Inc. (#565850368). The current census is six for (6) residents, the facility currently has six (6) residents. The fire clearance was granted on 07/21/2023; in which all rooms were cleared for bedridden residents. Component III was waived as the applicant currently operates three other Residential Care Facilities for the Elderly (RCFE)’s that are currently in good standing. Applicant has attended Component III in the past and is RCFE administrator certified.

The LPA toured the physical plant areas inside and outside with the applicant to ensure there are

no health and safety hazards and facility is in compliance with Title 22 Regulations.

BEDROOMS : There are (8) eight bedrooms in the facility; the facility has (6) six private bedrooms for resident use, and (2) two staff rooms. Both staff rooms are kept locked. Bedroom #5 does not have direct access to the outside. Lighting in the rooms appeared adequate. (6) six out of (6) six private resident rooms and (2) staff rooms were set up with beds, night stands, lamps, chests of drawers, chairs and closet space.

BATHROOMS: There are two (2) full bathrooms in the hallways. There are two (2) private bedroom

bathrooms for resident use; one full bathroom in the hallway is designated for staff and guests. The showers are equipped with nonskid surfaces and available nonskid mats. Grab bars were observed in the bathrooms. Hot water temperature in bathrooms measured between 108.3 – 112.6 degrees Fahrenheit.