195850209-2-20-2024-29-AS-DPEA-D2WNYG-20240229095240

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850209
Report Date: 02/20/2024
Date Signed: 02/20/2024 03:35:44 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/13/2022 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20220513101311

FACILITY NAME:	OAKMONT OF AGOURA HILLS		FACILITY NUMBER:	195850209
ADMINISTRATOR:	EL-RABAA, BASSEM		FACILITY TYPE:	740
ADDRESS:	29353 CANWOOD STREET		TELEPHONE:	(747) 755-5700
CITY:	AGOURA HILLS	STATE: CA	ZIP CODE:	91301
CAPACITY:	102	CENSUS: 73	DATE:	02/20/2024
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Lilit Chaparyan - Executive Director		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff sexually assaulted resident while in care.
Staff handled resident in a rough manner.
Staff is mishandling resident's medications.
Staff is not properly supervising residents while in care.
Residents not allowed to use the phone.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Brian Balisi and Martha Arroyo conducted a subsequent complaint visit to deliver final findings for the allegation listed above. During today’s visit, LPA met with Lilit Chaparyan and explained the reason for the visit.

On 05/16/2022, from 10:30 a.m. – 4:00 p.m., LPA initiated an unannounced complaint investigation for the allegations listed above. During the visit, LPA toured the physical plant, interviewed staff, residents and reviewed and obtained pertinent documents relevant to the investigation. On 12/19/2023, from 10:30 a.m. – 4:30 p.m., LPA conducted a subsequent complaint visit. During the visit, LPA toured physical plant, interviewed staff, and reviewed and obtained copies of additional documentation relevant to the investigation. On 12/20/2023, LPA interviewed Staff #1 (S1) and attempted to conduct follow up interviews on 01/10/2024 and 02/06/2024. On 01/05/2024 and 01/29/2024, LPA interviewed family/responsible parties of residents in care.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 4

Control Number 29-AS-20220513101311

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: OAKMONT OF AGOURA HILLS	FACILITY NUMBER: 195850209
	VISIT DATE: 02/20/2024

NARRATIVE

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Continued from 9099

On 12/20/2023, 01/10/2024 and 01/29/2024, LPA attempted to interview Staff #2 (S2), but was unsuccessful. On 01/29/2024, LPA interviewed the responsible party of Resident #1(R1). On 01/10/2024, 01/29/2024 and 02/06/2024, LPA attempted to interview the responsible party of Resident #2 (R2) but, was unsuccessful. LPA was unable to contact the reporting party to obtain any additional information.

It was reported that staff sexually assaulted a resident while in care, as it was alleged that S1 touched R1 in their pelvic area with malicious intent. Interviews conducted and records review revealed that Memory Care Director at the time of the complaint, Ivette Rios, was informed that S1 checked the diaper by pressing the back of their hand on the pelvic area of R1 without a glove. According to Rios, S1, first received approval from R1 before proceeding to check their diaper. R1’s significant other was also in the room along with S2, who S1 was shadowing at that time. S1 did not change the diaper of R1. Rios continued to state, staff are instructed to use gloves when providing incontinent care to residents, although S1 did not follow protocol of using gloves, Rios did not find any evidence of malicious intent from S1 when as they provided incontinent service to R1. Interviews conducted with ten (10) staff revealed that all ten (10) staff have not observed any staff conduct any lewd acts with any residents in care and all did not express any potential or immediate concerns of any other staff conducting any lewd acts to residents at this time. LPA’s interview with five (5) families/responsible parties of residents in care revealed that all five (5) did not express any potential or immediate concerns for staff servicing the residents at this time. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation “Staff sexually assaulted resident while in care” is deemed Unsubstantiated at this time.

It was reported that staff handled resident in a rough manner, as it was alleged that S1 was involved in a physical altercation with Resident #2 (R2). Interviews conducted with eleven (11) staff revealed that all eleven (11) staff have never observed S1 involved in a physical altercation with R2 or be physically aggressive with any resident in care. LPA’s interview with five (5) families/responsible parties of residents in care revealed that all five (5) did not express any potential or immediate concerns for staff servicing the residents at this time.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 29-AS-20220513101311

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: OAKMONT OF AGOURA HILLS	FACILITY NUMBER: 195850209
	VISIT DATE: 02/20/2024

NARRATIVE

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Continued from 9099-C
Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation “Staff handled resident in a rough manner” is deemed Unsubstantiated at this time.

It was reported that staff is mishandling resident’s medications, as it was alleged that Staff # 4 (S4) dropped medication on the floor and still administered it to a resident. S4 denied this allegation ever occurred. Interviews conducted with ten (10) staff revealed that all ten (10) staff have never observed any employee drop medication on the floor and still administer it to a resident. Each staff interviewed continued to state that if medication were to drop on the floor, they are trained to discard the medication and notate it in their medication records. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation “Staff is mishandling resident's medications” is deemed Unsubstantiated at this time.

It was reported that staff are not properly supervising residents while in care, as it was alleged that S1 attempted to take Resident #3 (R3) out of the facility at 6 a.m. Interviews conducted, and records reviewed reflected that S1 did in fact dress and prepare Resident #3 (R3) for a doctor’s appointment after R3 stated to S1 that they had a doctor’s appointment early in the morning. R3 who resided in the memory care wing, exited the wing with S1 pushing R3 in their wheelchair. The alarms sounded off and Staff #3 (S3) immediately responded and observed S1 and R3 waiting in the lobby. R3 was transported back to their room and S4 stated it was used as a teaching moment for S1 to remind S1 of the population they are servicing. During the incident, two (2) NOC shift caregivers and a med tech were on shift in memory care along with two (2) NOC shift caregivers and a med tech in assisted living. Although, S1 prepared R3 for an alleged morning appointment they never exited the facility property. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation “Staff is not properly supervising residents while in care” is deemed Unsubstantiated at this time.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20220513101311

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: OAKMONT OF AGOURA HILLS	FACILITY NUMBER: 195850209
	VISIT DATE: 02/20/2024

NARRATIVE

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Continued from 9099-C

It was reported that residents are not allowed to use the phone, as it was alleged that resident’s requests to use the phone but are denied. Interviews conducted with eleven (11) staff and five (5) responsible parties/families of residents in care revealed that all sixteen (16) persons interviewed have never observed a resident denied access to use a phone and all sixteen (16) persons interviewed also did not express any potential or immediate concerns for any residents unable to use a phone. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation “Residents are not allowed to use the phone.” is deemed Unsubstantiated at this time.

Exit interview conducted and a copy of report issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 4