195850209-6-2-2023-29-AS-DPEA-CT6QLX-20230626121636

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850209
Report Date: 06/02/2023
Date Signed: 06/02/2023 02:43:39 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
12/15/2022 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20221215141630

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:	102	CENSUS: 66	DATE:	06/02/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Ivette Rios - Regional Memory Care Specialist		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff do not provide adequate food service.

Facility is in disrepair.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced subsequent complaint investigation for the allegations listed above. Upon arrival LPA met with Ivette Rios - Regional Memory Care Specialist and explained the reason for the visit.
On 12/19/2022 between 9:30am - 2:30pm, LPA conducted initial complaint visit and toured physical plant, interviewed staff, residents and reviewed and obtained copies of pertinent documentation relevant to the investigation. On 01/23/2023 between 2pm-4pm, LPA conducted subsequent visit and toured physical plant, interviewed staff, residents and reviewed and obtained additional documents relevant to the investigation.

It was reported that staff do not provide adequate food service, as it was alleged that food was not edible and food was being served cold due to long wait times. LPA's interview with (10) residents revealed that (8) out of the (10) residents stated they have never been served cold food due to long wait times. The eight (8) residents also stated the facility offers a variety of food that is nutritious and most of the time flavorful.

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: 06/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023

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

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20221215141630

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: 06/02/2023

NARRATIVE

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Continued from 9099
LPA's interview with (3) dining room staff revealed that upon receiving the order from the resident , the goal is for the food to go out within 10 - 15mins. Staff continued to state very rarely does food take over 15 mins to get to the table. The staff that were interviewed could also not recall any resident bringing up concerns of cold food at this time. In the event a resident does complain about cold food, Staff stated their protocol would be to bring it back to the kitchen and replace it with a freshly made entrée. On 1/23/2023, LPA observed lunch in dining room. Observations revealed food was typically served to residents within 5 to 10 mins upon ordering. The food served also appeared to be edible, nutritious with sufficient proportions. Based on information gathered during this and previous visits. The department does not have sufficient evidence to prove this allegation occurred. Therefore the allegation that Staff do not provide adequate food service has been deemed UNSUBSTANTIATED at this time.

It was reported that facility is in disrepair, as it was alleged that facility failed to keep water and electrical systems maintained resulting in residents to not have water and power for an extended period of time. Interviews and records review revealed, on 11/17/2022, a third party agency conducted a suppression system inspection and observed that the facility's water pressure was running too high. Interview with Maintenance staff further revealed on 11/23/2022, an underground pipe located 6ft underground was excavated and observed to have a tear, resulting in the high water pressure. The initial repair was completed on the same day. On 11/28/2022, the work completed on the piping was inspected and observed to have some concerns of moisture. On 11/30/2022, the pipe was completely repaired. On 01/24/2023, LPA's interview with the Contractor responsible for installing the piping in the facility, stated there were no preventative measures the facility staff could have conducted to prevent the leak from occurring. During the time of the water stoppage, residents were provided with water bottles and transportation was made available for any resident who wanted to use the restroom at one of the nearby businesses. Interviews and records review also revealed on 12/13/2022 and 12/14/2022, the power was shut off due to Southern California Edison conducting repair work in the area. During the time of the power outages, residents were provided with lanterns, generators were available for use, and the Executive Director along with (10) staff members worked nights shifts to conduct hourly checks and provide assistance to residents. Based on information gathered during this and previous visits, the department does not have sufficient evidence to prove this allegation occurred. Therefore, the allegation that facility is in disrepair has been Unsubstantiated at this time.
Exit interview conducted and report issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023

LIC9099 (FAS) - (06/04)

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