195850209-7-11-2023-29-AS-DPEA-CW63TK-20230929183203

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850209
Report Date: 07/11/2023
Date Signed: 07/11/2023 04:43:03 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
07/06/2022 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20220706153009

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: 66	DATE:	07/11/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Lily Chaparyan - Executive Director		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff are not making sure residents are taken to appointments
Unqualified staff providing care to residents
Staff left resident unattended
Staff are not providing adequate food service to residents
Staff are not meeting residents laundry needs
Staff are not providing residents with outdoor activities
Resident is not awarded privacy
Facility has no safety plan
Facility call button system is in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent complaint visit to deliver final findings for the above allegations. During today’s visit, LPA met with Lily Chaparyan - Executive Director and explained the reason for the visit.

On 07/06/2022, the Department received a complaint regarding the following allegations: Staff are not making sure residents are taken to appointments, Unqualified staff providing care to residents, Staff left resident unattended, Staff are not providing adequate food service to residents, Staff are not meeting residents laundry needs, Staff are not providing residents with outdoor activities, Resident is not awarded privacy, Facility has not safety plan and Facility call button system is in disrepair.

On 07/11/2022, from 11am to 4pm, LPA Brian Balisi initiated an unannounced complaint investigation for the allegations listed above. Upon arrival LPA met with Heatlh and Services Director Amandeep Saund, and explained the reason for the visit.

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 5

Control Number 29-AS-20220706153009

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

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Continued from 9099

At approximately 11am, the LPA conducted a physical plant tour, interviewed residents and staff as well as reviewed and obtained copies of pertinent documents relevant to the investigation.

On 06/02/2023, from 1:30pm to 3:30pm, LPA conducted an unannounced subsequent complaint visit to continue the investigation. Upon arrival LPA met with Ivette Rios - Regional Memory Care Specialist and explained the reason for the visit. At approximately 1:30pm, LPA conducted physical plant, interviewed additional residents as well as reviewed and obtained additional documents relevant to the investigation.

It was reported that Staff are not making sure residents are taken to appointments, as it was alleged that staff are not taking residents to appointments. LPA’s interview with twelve (12) residents revealed that all twelve (12) are satisfied with staff transporting them to their appointments. Further, all residents interviewed stated very rarely have they experienced delays, but if that occurs, staff have provided alternate modes of transportation via Uber or as a last resort contacting a family member or responsible party. LPA's interview with responsible parties of five (5) of the residents revealed that all five (5) of the responsible parties are satisfied with staff ensuring their residents are being taken to their appointments. Interviews with the responsible parties further revealed that did not express any potential or immediate concerns that the residents would not be able to make any appointments. Based on information gathered during the course of the investigation, the Department does not have sufficient evidence to prove this allegation occurred. Therefore the allegation that Staff are not making sure residents are taken to appointments, is deemed Unsubstantiated at this time.

It was reported that Unqualified staff providing care to residents, as it was alleged that the facility does not have a Licensed Vocational Nurse (LVN), interviews conducted, and records review revealed that Health and Services Director Aman Saund was employed during the time of the complaint and held a Vocational Nurse License. Based on information gathered during the course of the investigation the Department does not have sufficient evidence to determine this allegation occurred. Therefore, the allegation that Unqualified staff providing care to residents is deemed Unsubstantiated at this time.

It was reported that Staff left resident unattended, as it was alleged that a resident with a white wrist band was observed in the lobby by the front entrance with (2) staff members sitting in the balcony.

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 5

Control Number 29-AS-20220706153009

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

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Continued from 9099-C
Interviews conducted and records review revealed that exits leading to the outside of the community are equipped with a wanderguard system and Resident #2 (R2), who utilized a wanderguard bracelet, would frequent the front entrance lobby. Interviews further revealed that R2 would become agitated if observed closely by staff, so staff were instructed that if R2 was observed near an exit to observe at a distance, but in close enough proximity to redirect if R2 attempted to exit the facility. Records review of staff schedule further revealed there is typically at least four (4) caregivers, two (2) med techs scheduled per shift in Assisted living and Memory care along with Administrative staff. During the NOC shift, typically there is at least two (2) caregivers and one (1) med tech scheduled in Assisted living and memory care. The Receptionist is also scheduled from 8am to 8pm. After 8pm, the front doors are locked and a code is required to enter the facility. LPA’s interview with twelve (12) residents revealed all twelve (12) did not express any potential or immediate concerns of any resident being left unattended. Based on information obtained during the course of the investigation, the department does not have sufficient evidence to prove this allegation occurred. Therefore, the allegation that staff left resident unattended is deemed Unsubstantiated at this time.

It was reported that Staff are not providing adequate food service to residents, as it was alleged that food is always served cold and residents have had to wait 2 hours for food. LPA’s interview with twelve (12) residents revealed that eleven (11) out of the twelve (12), residents stated they have never been served cold food or experienced long wait times. The one (1) resident who stated they weren’t satisfied with the food services had mentioned that their negative experiences were from when the facility first opened and since then the food and the service has improved. 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 07/11/2023, 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 the investigation The department does not have sufficient evidence to prove this allegation occurred. Therefore, the allegation that staff are not providing adequate food service to residents 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: 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: 3 of 5

Control Number 29-AS-20220706153009

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

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Continued from 9099-C

It was reported Staff are not meeting residents’ laundry needs as it was alleged that laundry is not being done weekly. LPA’s interview with twelve (12) residents revealed that all twelve (12) residents get their laundry cleaned at least once a week and upon request. The (12) residents continued to state that they are satisfied with staff servicing their laundry. LPA’s records review of Assisted Living Laundry schedule revealed that at least five (5) rooms are scheduled per day during the week. Based on information gathered during the investigation, the department does not have sufficient evidence to prove this allegation occurred. Therefore, the allegation that Staff are not meeting residents’ laundry needs is deemed Unsubstantiated at this time.

It was reported that Staff are not providing residents with outdoor activities, as it was alleged that residents have not been on outings to the store. LPA’s interview with twelve (12) residents revealed that eight (8) out of the twelve have participated in outings to stores in the area. Four (4) out of the twelve (12) interviewed stated they are aware the facility provides outings, but they have yet to participate. During physical plant LPA observed signup sheet, which indicated outings were scheduled on the following days: Monday 07/11/2022 to Vons from 1:30 – 2:30, Monday 07/11/2022 to Target from 3:30 – 4:30 and Friday 07/15/2022 on a scenic drive from 2:30 – 4:00. LPA’s records review of July 2022 Activities calendar revealed multiple activities being conducted outdoors in the garden, the courtyard as well as an outdoor walking club. Based on information gathered during the investigation, the department does not have sufficient evidence to prove this allegation occurred. Therefore, the allegation that Staff are not providing residents with outdoor activities is deemed Unsubstantiated at this time.

It was reported that Resident is not awarded privacy, as it was alleged that staff entered Resident #1 (R1)’s room without knocking. Interviews conducted revealed that all staff interviewed denied the allegation of walking into a resident’s room without first knocking or announcing themselves ever occurred. LPA’s interview with twelve (12) residents revealed that all twelve (12) residents have never experienced a staff member entering their room without knocking or announcing themselves first. Based on information gathered during the investigation, the department does not have sufficient evidence to prove this allegation occurred. Therefore, the allegation that Resident is not awarded privacy, 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: 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: 4 of 5

Control Number 29-AS-20220706153009

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

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Continued from 9099-C

It was reported that Facility has no safety plan, as it was alleged that there was a power outage that occurred in the evening and residents were informed over the intercom to remain in their room. This led the complainant to believe that there is no safety plan in place. Interviews conducted and records review revealed that an Emergency Disaster Plan (LIC610E) is kept on site. In the event of a disaster/emergency including long term power failure, the facility has documented procedures to be self-reliant for at least 72 hours. Staff communicate with emergency services and licensing agencies on an ongoing basis to discuss evacuation/relocation. Appropriate staff safety supervisors coordinate ongoing provision of resident care, and residents are discouraged from going outside during the 72 hour self-reliance in the event of a major disaster/emergency. Staff have a disaster/emergency training record documented in the facility disaster manual. Staff also have a documented disaster drill record occurring at least once every 6 months for each shift. LPA’s interview with twelve (12) residents revealed that all twelve (12) residents did not express any potential or immediate concerns of staff not knowing what to do in the event of an emergency. Based on information gathered during the investigation, the department does not have sufficient evidence to prove this allegation occurred. Therefore, the allegation that Facility has no safety plan is deemed Unsubstantiated at this time.

It was reported that Facility call button system is in disrepair, as it was alleged that when the Former Executive Director pushed R1’s alert button, it activated a signal for a different room. Interview with staff and Executive Director denied the allegation occurred. During physical plant tour on 06/02/2023, LPA activated signals for six (6) different units and each signaled the correct room. LPA also observed staff visit resident with activated alarm within 3 – 5 mins. Based on information gathered during the course of the investigation, the department does not have sufficient evidence to prove this allegation occurred. Therefore, the allegation that Facility call button system is in disrepair 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: 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)

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