195850209-7-11-2023-29-AS-DPEA-CU2URR-20230724154911

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850209
Report Date: 07/11/2023
Date Signed: 07/11/2023 04:39:55 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
02/14/2022 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-NP-20220214151407

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:	ZIP CODE:	91301
CAPACITY:	102	CENSUS: 66	DATE:	07/11/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Lily Chaparyan - Executive Director		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Unlicensed Care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced subsequent complaint visit to deliver final findings for the allegation listed above. Upon arrival LPA met with Executive Director Lily Chaparyan and explained the reason for the visit.

On 02/14/2022, CCLD received a complaint, which stated Unlicensed Care was being provided for residents, who were temporarily residing at local hotels near the facility, until the facility was officially licensed. The facility became licensed on 02/15/2022.

On 02/23/2022 approximately between 9am - 3:30pm, LPAs Brian Balisi and Zabel Chochian conducted the initial complaint visit. During the visit, LPAs conducted physical plant, interviewed seven (7) residents, (8) resident families or responsible parties and (2) staff, as well as reviewed and obtained copies of pertinent documents relevant to the investigation.

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: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

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 2

Control Number 29-NP-20220214151407

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: 07/11/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued from 9099

It was reported that unlicensed care was being provided, as it was alleged that residents who required assistance with Activities of Daily Living (ADL) were temporarily residing at nearby hotels. Interviews conducted and records review revealed that no resident was admitted into the facility until the license was received on 02/15/2022. At least seven (7) residents were temporarily residing at nearby hotels, five (5) residents were residing at other licensed facilities, two (2) residents were in Skilled nursing facilities and the rest were either living at home or with loved ones. Of the seven (7) residents who were staying at hotels, each resident and their family or responsible party stated they did not observe any facility staff providing care or assistance at the hotels. Interviews with families or responsible parties further revealed that all residents were only admitted into the facility once they received notification that the facility received their license. Based on the information obtained, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of unlicensed care was being provided, has been 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: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2