Facility Evaluation Report

Licensing Program Analyst (LPA) Elsie Campos arrived at the facility announced at 10:30 a.m. to conduct a

pre-licensing inspection and conducted a subsequent visit unrelated to the pre-licensing inspection at this facility. LPA met with Administrator Connie Roush. This is a change of ownership application from Colony of Thousand Oaks at Sidlee West, Inc. (#565850181) to Colony of Thousand Oaks at Sidlee West Inc. (#565850370). The current census is six for (6) residents, the facility currently has five (5) 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. Room #4, #6 do 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, nightstands, lamps, chests of drawers, chairs and closet space.

BATHROOMS : There is (1) half bath and (1) full bathroom in the hallway. There are two (2) private bedroom bathrooms for resident use; the half bathroom in the hallway is designated for staff and guests, the full bathroom in the hallway is designated for resident use. 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 105.0 – 108.6 degrees Fahrenheit.