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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850209
Report Date: 01/29/2024
Date Signed: 01/29/2024 03:16:53 PM


Document Has Been Signed on 01/29/2024 03:16 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 HILLSFACILITY NUMBER:
195850209
ADMINISTRATOR:LILIT CHAPARYANFACILITY TYPE:
740
ADDRESS:29353 CANWOOD STREETTELEPHONE:
(747) 755-5700
CITY:AGOURA HILLSSTATE: CAZIP CODE:
91301
CAPACITY:102CENSUS: 78DATE:
01/29/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Beatriz Martinez - Health Services Director TIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced Case Mangement - Incident visit to follow up on a LIC 624 Incident report and SOC 341 received by the department on 01/25/2024. LPA met with Health Services Director Beatriz Martinez and explained the reason for the visit.

On 01/25/2024, the department reviewed a SOC 341 for Resident #1 (R1) sent by facility staff. The report indicated that on 01/23/2024,the Executive Director Lily Chaparyan, received information from a family member of R1, that Staff #1 (S1), verbally abused R1.

At approx 10:00am, LPA conducted physical plant, interviewed staff, residents and families as well as reviewed and obtained pertinent documents relevant to the investigation. According to Martinez, the incident is still under investigation. LPA did not observe any immediate or potential health and safety concerns at this time.

The LPA has determined further investigation is needed and will return at a later date to complete the investigation if warranted.

Exit interview conducted and copy of report issued.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian BalisiTELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:
DATE: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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