Colony of Thousand Oaks at Greenfield

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 9:45 a.m. Upon arrival, LPA Mosley was greeted by staff who called the Administrator to inform them of the visit. The Administrator / Licensee Representative, Dr. Rashita Aggarwal and Co-Administrator Christopher Romo arrived shortly after and the reason for the visit was explained. Entrance interview. The LPA and staff / Administrator 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. COMMON AREAS: This includes the living room, and dining room. At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 12:01 p.m., hardwire combination of smoke / carbon monoxide detectors and fire door were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 11/14/2025. The emergency exiting plans/sketch are posted. The emergency telephone numbers are posted in the common hallway. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 10/04/2025 and are conducted quarterly. Activities were observed in the common areas. The fireplace in the living room was adequately screened. There is a functioning telephone on the premises. Auditory alarms at the entrances and exits were observed and functional at the time of the visit. LPA observed surveillance cameras installed in the common areas of the facility. The Administrator presented the live monitoring screen to the LPA, confirming that all cameras were functioning properly and that none of them were equipped with audio capability. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809-C... INTERVIEWS: Starting at 9:55 a.m. and throughout the visit two (2) staff and two (2) resident interviews were conducted. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interview revealed that no concerns were noted or voiced at the time of the visit. BEDROOMS: There are eight (8) total bedrooms in the facility; six (6) bedrooms are designated as private, single occupancy, resident rooms and two (2) staff rooms. The staff rooms are kept locked at all times and observed to be occupied by staff. Five (5) out of six (6) resident rooms have exits to the exterior. All passageways were observed to be clear of obstructions. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: There are three (3) total restrooms. Two (2) are designated as a shared / common resident restroom, and One (1) is designated as a private resident restroom. Resident restrooms were observed to be equipped with a slip resistant surface / mat. Grab bars were observed in the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in all resident restrooms and ranged between 105.0 - 112.5 degrees Fahrenheit, all within the required range. LPA observed storage space closets in hallway containing extra clean linens and towels for resident use. KITCHEN: The LPA inspected the kitchen/food service area at 10:18 a.m. Knives and sharps were observed in a locked cabinet. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 112.1 degrees Fahrenheit at 10:19 a.m. Cleaning supplies and other chemicals are kept locked under the sink, the hallway chemical closet and in the garage locked and inaccessible to residents in care. GARAGE: LPA observed the attached garage accessible through the kitchen, which was locked at the time of the visit. LPA observed emergency food and water, personal protection equipment (PPE) , incontinent supplies, and an extra refrigerator/freezer that was checked for proper labels and expiration dates. LPA observed laundry units and laundry detergent. LPA observed a storage closet with supplies. Report Continued on LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2... RECORDS: Resident Records: were reviewed beginning at 10:32 a.m. six (6) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All records were in order. Personnel Records were reviewed beginning at 11:33 a.m. five (5) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. Both documents were observed to be complete and updated annually as required. The facilities policies and procedures, as they pertain to infection control and emergency planning meet the regulatory standard. MEDICATIONS: Medication review began at approximately 12:05 p.m. Medications are centrally stored and locked in a cabinet in the kitchen adjacent to the dining room. Medications for three (3) residents were reviewed. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed during review. LPA observed the first aid supplies to be complete, including a thermometer and a current version of a first aid manual. DOCUMENTS: Documents obtained during the visit include: LIC 500 facility roster and LIC 9020A Resident roster and copy of the Limited Liability insurance. During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of report reviewed and provided.the state’s words, verbatim · CDSS document, Nov 14, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced at 11:36AM to conduct an annual inspection. LPA initially met with facility staff. Facility Designees and Licensee/Administrator were contacted via telephone. Facility Designee Eleanor Jimenez arrived shortly after the visit began; remaining 3 (three) managers arrived throughout the visit. Entrance interview conducted. Beginning at 12:11PM, the LPA, along with facility management 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 observed: Fire extinguishers were observed to be fully charged and recently serviced 10/04/2024. Hardwired combination smoke and carbon monoxide detectors were tested at 02:10PM. All were functional at the time of the visit. 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. Lighting in the resident rooms appeared adequate. All resident rooms were observed and were furnished appropriately at the time of the visit. BATHROOMS: There is (1) half bath and (1) full bathroom in the hallway. There is (1) one additional private bathroom 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 shared resident bathroom measured at 115.1 degrees Fahrenheit, which is within the required range. COMMON AREAS: The common areas were appropriately furnished, and the lighting was adequate. There is a television and other entertainment equipment in the living room area. All furnishings were observed in good condition. All required postings were observed in common areas. Report Continued on LIC 809-C EXTERIOR: The exterior passageway was clean and clear of any obstructions. There is a patio area in the backyard with a shaded table and chairs for resident use. The back and sides of the house are separated from the front yard by a gate with a self-latching mechanism. KITCHEN: Kitchen knives are stored locked and inaccessible in a drawer next to the sink. Cleaning supplies are locked in an under-sink cabinet. The supply of perishable and nonperishable food is adequate. Appliances in the kitchen were clean and appeared functional. There is an adequate supply of emergency food and water. GARAGE: The garage was observed locked and inaccessible to residents in care. The garage contained storage, a refrigerator/freezer containing extra food, as well as the facility's laundry area. FILES: Beginning at 12:33PM, LPA observed 5 (five) resident files for items including but not limited to physician's report, physician's orders, needs and service appraisals, and personal rights. All resident files were in order. LPA observed 2 (two) staff files for items including but not limited to health screening, TB test, criminal record clearance, and training records. All staff records were observed to be complete. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: The facility has an infection control plan and emergency disaster plan; both of which were observed to be complete and updated annually as required. Emergency disaster drills are conducted quarterly, with the last drill documented on 11/03/2024. MEDICATIONS: Medications are stored in a locked cabinet in the kitchen. The first aid supplies were complete, including a first aid manual. At 01:45PM, medications for 2 (two) residents were observed. Medications for both residents were observed to be properly stored and documented per regulation. INTERVIEWS: During today's visit, LPA conducted interviews with both staff and residents. No concerns were noted during interviews. No citations issued. Exit interview was conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Nov 14, 2024

Type of visit: Prelicensing

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. Continued on LIC 809-C COMMON AREA: The common areas were appropriately furnished, and the lighting was adequate. There is a television and other entertainment equipment in the living room area. The facility smoke alarm system is hardwired; the smoke detectors were operable at the time of the visit. There are three (3) fire extinguishers. which were fully charged and last serviced 11/8/2022. There is a functioning telephone on the premises. Emergency exiting plans/sketch are posted. Emergency telephone numbers are posted at the entrance area wall. Other required postings are also posted on the dining area wall and living room wall. KITCHEN: Kitchen knives are stored locked and inaccessible in a drawer on the right side of the kitchen sink. The supply of perishable and nonperishable food is adequate. The supply of dishes is adequate. The kitchen has recently undergone a full remodel. Appliances in the kitchen were new, clean and functional. There is an adequate supply of emergency food. MEDICATIONS: Medications are in a locked cabinet in the kitchen. The first aid supplies were complete, including a first aid manual. FILES: Resident and staff records are locked and stored in a cabinet in the living room. LAUNDRY: The laundry area is located in the attached garage. Laundry detergent and chemicals are locked and stored inaccessible. EXTERIOR: The exterior passageways were clean and clear of any obstructions. The backyard is set up with tables, an umbrella for shade and chairs for resident use. There are no bodies of water noted on the premises. The back and sides of the house are separated from the front yard by gates at the north and south-side passageways, one gate has a self-latching mechanism. There is no front yard gate or driveway gate. There are no other structures on the property. INFECTION CONTROL: The facility has a central entry point for symptom screening and sanitation station for staff, residents, and visitors. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. Facility is in compliance with Title 22 Regulations at this time. This report will be sent to the Centralized Application Bureau (CAB). The CAB Analyst will notify the applicant when the license has been approved. The applicant is aware that they are unable to operate under the new license number until they have been notified that the license has been approved by the CAB Analyst. Failure to comply could affect approval of the license. Exit interview conducted and report issued.the state’s words, verbatim · CDSS document, Oct 18, 2023