Facility Evaluation Report

Licensing Program Analyst (LPA) Elsie Campos arrived at the facility announced at 9:45 a.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 Venus (#565850186) to Colony of Thousand Oaks at Venus, Inc. (#565850369). 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.

At 10:10 a.m., 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, #5 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 are (2) two full bathrooms in the hallways. There are two (2) private bedroom bathrooms for resident use; the full bathroom in the hallway to the right of the living room is designated for staff and guests, the full bathroom in the hallway to the left 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 113.1 – 120.7 degrees Fahrenheit.