195850209-6-20-2024-29-AS-DPEA-D6MLJ4-20240627084719

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850209
Report Date: 06/20/2024
Date Signed: 06/20/2024 03:03:10 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
01/02/2024 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20240102153123

FACILITY NAME:	OAKMONT OF AGOURA HILLS		FACILITY NUMBER:	195850209
ADMINISTRATOR:	SAHAR MOSALLA		FACILITY TYPE:	740
ADDRESS:	29353 CANWOOD STREET		TELEPHONE:	(747) 755-5700
CITY:	AGOURA HILLS	STATE: CA	ZIP CODE:	91301
CAPACITY:	0	CENSUS: 0	DATE:	06/20/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Lily Chaparyan		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff are not providing assistance to a resident while eating

Staff are not ensuring a resident is being showered while in care

Staff do not meet a resident's incontinence needs while in care

Staff provided medical advice to a resident without proper authorization

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent complaint visit to investigate final allegations listed above. During today’s visit, LPA met Lily Chaparyan with and explained the reason for the visit.
On 01/08/2024, from 11:15 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 01/29/2024, from 10:00 a.m. – 4:oo p.m. LPA interviewed four (4) family member / responsible parties of residents in care while conducting a subsequent visit on a separate investigation.

It was reported that “Staff are not providing assistance to a resident while eating” as it was alleged that Resident #1 (R1) is not being assisted when eating. Interviews conducted with nine (9) staff revealed that five (5) staff have personally assisted R1 with eating, either by encouraging R1 to eat, guiding them with utensils, or cutting their food into small pieces.

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: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

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 3

Control Number 29-AS-20240102153123

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: 06/20/2024

NARRATIVE

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The other four (4) staff interviewed stated they have not personally assisted R1 with their food. All (9) staff confirmed that they have observed staff providing assistance to residents who require help with feeding. In addition, interviews with six (6) family members / responsible parties indicated that none of them expressed concerns about staff not assisting residents with eating. 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 are not providing assistance to a resident while eating.” is deemed Unsubstantiated at this time.

It was reported that “Staff are not ensuring a resident is being showered while in care”, as it was alleged that R1 is not being showered twice a week. Interviews conducted with nine (9) staff revealed that none of them have observed any resident go more than three (3) days without a shower. Records review interviews conducted with further revealed R1 is showered at least twice a week. Staff also stated that residents usually receive showers two to three times a week or as needed. Additionally, interviews with six (6) family members / responsible parties showed that none of them expressed concerns about staff not showering residents for an extended period. . 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 are not ensuring a resident is being showered while in care.” is deemed Unsubstantiated at this time

It was reported that “Staff do not meet resident’s incontinence needs while in care”, as it was alleged that R1’s diaper is not being changed in a timely manner. Interviews conducted with nine (9) staff revealed that six (6) staff have never observed any instances of residents' diapers not being changed in a timely manner. The other three (3) staff interviewed reported that they have noticed a few residents with overly soaked diapers when checked in the morning on some occasions. These three staff members also confirmed that they have not seen R1's diaper left unchanged, and the instances of overly soaked diapers occurred months ago and have not happened recently. LPA’s interviews conducted with six (6) family members / responsible parties revealed that all (6) did not express any potential or immediate concerns for staff not servicing residents’ incontinence needs while in care. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20240102153123

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: 06/20/2024

NARRATIVE

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Continued from 809-C

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 do not meet resident’s incontinence needs while in care” is deemed Unsubstantiated at this time.

It was reported that “staff provided medical advice to a resident without proper authorization” as it was alleged that the facility attempted to place R1 on hospice without authorization from family member / responsible party. LPAs Interviews with Memory Care Director Orion Richardson and Executive Director Lily Chaparyan revealed that R1 was not placed on hospice without authorization from R1’s responsible party. However, Richardson did suggest to R1’s family member/responsible party that placing R1 on hospice could provide additional showers beyond the two (2) weekly showers scheduled at the facility along with additional care that hospice provides. During LPA’s interview with R1’s family member/responsible party, it was disclosed that after further discussions with Richardson and Chaparyan, they gained a better understanding of hospice services but still believed R1 was not currently a suitable candidate for hospice. 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 provided medical advice to a resident without proper authorization.” is deemed Unsubstantiated at this time.

Exit interview conducted and 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: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

LIC9099 (FAS) - (06/04)

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