Inspection Reports for Conejo Valley Home Care
2476 Drayton Ave, Thousand Oaks, CA 91360, United States, CA, 91360
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Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 1
Jan 28, 2025
Visit Reason
The inspection was an unannounced required annual inspection conducted to ensure the facility's compliance with Title 22 Regulations and health and safety standards.
Findings
The facility was generally found to be in compliance with health and safety regulations, with clean and well-maintained bedrooms, bathrooms, common areas, kitchen, and outdoor areas. However, a deficiency was cited for failure to conduct and document reappraisals/needs and service appraisals in 5 out of 5 resident files reviewed, posing a potential health and personal rights risk.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Licensee did not comply with reappraisal requirements; 5 out of 5 resident files reviewed lacked reappraisal/needs and service appraisal documentation. | Type B |
Report Facts
Residents missing reappraisal documentation: 5
Capacity: 6
Census: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Dulek | Licensing Program Analyst | Conducted the inspection and authored the report |
| Kristin Heffernan | Licensing Program Manager | Supervisor of the inspection and named in the report |
| Melissa Shubin | Incoming Administrator | Met during inspection and agreed to plan of correction |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 3
Feb 21, 2024
Visit Reason
The inspection was an unannounced required annual inspection to ensure the facility's compliance with Title 22 Regulations and health and safety standards.
Findings
The facility was generally found to be in compliance with physical plant and safety requirements, including kitchen, bedrooms, bathrooms, common areas, and outdoor areas. However, deficiencies were cited related to staff night supervision training, incomplete resident appraisals, and missing emergency contact information in resident files.
Deficiencies (3)
| Description |
|---|
| Two out of two night staff are not trained in first aid as required, posing an immediate health, safety or personal rights risk to persons in care. |
| Six out of six residents did not have a completed appraisal prior to admission, posing a potential health, safety or personal rights risk to persons in care. |
| Four out of six resident files did not have a completed emergency contact form, posing a potential health, safety or personal rights risk to persons in care. |
Report Facts
Residents missing Identification and Emergency Contact form: 4
Residents missing Resident Appraisal form: 5
Personnel files missing Health Screening Form: 6
Personnel files missing Personnel/Employment form: 1
Night staff not trained in first aid: 2
Residents without completed appraisal: 6
Residents missing emergency contact form: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sandra Urena | Licensing Program Analyst | Conducted the inspection and signed the report |
| Kasandra Lopez | Licensing Program Manager | Supervisor overseeing the inspection |
| Melissa Briones | Facility designated staff present during inspection | |
| Kevin Fitzgerald | Administrator | Facility administrator named in report header |
Inspection Report
Original Licensing
Capacity: 6
Deficiencies: 0
Feb 3, 2023
Visit Reason
A pre-licensing visit was conducted to evaluate the facility for fire safety, personal accommodations and services, and food service in preparation for initial licensing.
Findings
The facility was found to be in compliance with Title 22 regulations at the time of the visit, with all safety equipment functioning properly, adequate accommodations, sufficient supplies, and proper storage of medications and cleaning supplies.
Report Facts
Fire clearance capacity: 6
Hot water temperature: 111.2
Hot water temperature: 109.4
Food supply: 7
Capacity: 6
Census: 0
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kevin Fitzgerald | Applicant Representative / Administrator | Met with Licensing Program Analyst during pre-licensing visit |
| Martha Arroyo | Licensing Program Analyst | Conducted the pre-licensing visit and inspection |
| Desaree Perera | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Original Licensing
Capacity: 6
Deficiencies: 0
Jan 26, 2023
Visit Reason
Initial licensing evaluation of Conejo Valley Home Care Facility to verify applicant/administrator understanding of community care facility licensing laws and readiness for operation.
Findings
The applicant/administrator demonstrated understanding of licensing laws, facility operation, admission policies, staffing, restrictive health conditions, emergency preparedness, complaints reporting, and pre-licensing readiness. No clients were in care at the time of the evaluation.
Report Facts
Capacity: 6
Census: 0
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kevin Fitzgerald | Administrator/Corp Member | Met with during evaluation and confirmed understanding of licensing requirements |
| Jude De La Concepcion | Licensing Program Manager | Named as Licensing Program Manager on report |
| Marisa Holabird | Licensing Program Analyst | Named as Licensing Program Analyst and signed report |
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