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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608037
Report Date: 11/09/2021
Date Signed: 11/10/2021 02:55:37 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/28/2021 and conducted by Evaluator Lourdes Montoya
COMPLAINT CONTROL NUMBER: 11-AS-20211028105238
FACILITY NAME:OATHPARKFACILITY NUMBER:
197608037
ADMINISTRATOR:DENETRA NORWOODFACILITY TYPE:
740
ADDRESS:3518 WEST SIXTIETH STREETTELEPHONE:
(323) 920-6994
CITY:LOS ANGELESSTATE: CAZIP CODE:
90043
CAPACITY:6CENSUS: 3DATE:
11/09/2021
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:DENETRA NORWOODTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Facility was unkept
Facility smelled of marijuana.
Staff has not allowed residents' authorized representative to visit on several occasions.

INVESTIGATION FINDINGS:
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On 11/9/2021, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced subsequent complain visit at this facility. LPA met with Administrator Denetra Norwood, and explained the purpose of today's visit is to gather additional information and deliver findings for allegations mentioned above.

The investigation consisted of the following: LPA inquired questions relevant to the nature of the complaint. LPA Lourdes Montoya and Licensing Program Manager (LPM) Angela Kendrick conducted interviews with Staff (S2), Residents (R1-R2) and Guest (W1) on 11/5/2021. Staff #1 (S1) was not present during the visit due to a medical appointment while Resident (R3) was also not available due to work. LPA attempted to obtain and review facility records on 11/5/2021 but they were not available. A tour of the entire facility was conducted on 11/5/2021.

Report continued in LIC 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021
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 11-AS-20211028105238
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME: OATHPARK
FACILITY NUMBER: 197608037
VISIT DATE: 11/09/2021
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Facility was unkept.
It is alleged facility was unkept. The complainant reported the facility living room was unkept, messy with clothing and shoe items on the floor. The Department observed during an unannounced visit the facility was unkept, unfolded clothes and shoes were scattered on the floor and on the couch in the living room; the garage was full of debris including empty water bottles, boxes, white plastic bags and other unseen stuff inside the garage. Based on the information gathered, there is sufficient evidence to corroborate the allegation mentioned above.

Allegation: Facility smelled of marijuana.


It is alleged facility smelled of marijuana. The complainant reported a heavy smell of marijuana was coming out from the facility. During an unannounced visit, the Department smelled a strong incense of marijuana while waiting at the front door. It was revealed furthermore by the department’s observation and interview that R1 smokes marijuana in the facility. While R1 denied smoking marijuana, interview with Resident (R2), Staff (S2) and Guest (W1) revealed R1 smokes marijuana in his bedroom and around the house. S2 also stated R1 smokes marijuana for pleasure and not for medical purposes. Based on the information gathered, there is sufficient evidence to corroborate the allegation mentioned above.

Allegation: Staff has not allowed residents’ authorized representative to visit on several occasions.


It is alleged staff has not allowed residents’ authorized representative to visit on several occasions. The complainant reported Ombudsman attempted to visit the facility four (4) times on February, April, August and October of 2021 but facility staff denied the Ombudsman entry three (3) times out of those four visits due to the pandemic. Ombudsman was allowed entry only in April 2021. The department interviewed Staff (S2) who revealed she denied entry to the Ombudsman three times based on the administrator’s instructions. S2 explained the administrator does not allow any guest in the facility due to the pandemic. Resident (R2) disclosed during interview he is aware that Ombudsman was denied entry to the facility a few times. Resident (R1) and Guest (W1) stated they don’t know whether or not facility staff has not allowed residents’ authorized representative to visit on several occasions. Based on the information gathered, there is sufficient evidence to corroborate the allegation mentioned above.

Report continued in LIC 9099C
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20211028105238
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME: OATHPARK
FACILITY NUMBER: 197608037
VISIT DATE: 11/09/2021
NARRATIVE
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Based on LPAs observations and interviews which were conducted, the preponderance of evidence standard has been met therefore the above allegations, “Facility was unkept”, “Facility smelled of marijuana”, “Staff has not allowed residents’ authorized representative to visit on several occasions” are found to be substantiated.

Deficiencies are being cited on the attached LIC 9099D. Exit interview conducted. Copy of this report and appeal rights explained.
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20211028105238
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754

FACILITY NAME: OATHPARK
FACILITY NUMBER: 197608037
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/09/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/15/2021
Section Cited
CCR
87303(a)
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87303(a) Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:
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Licensee/Administrator agreed to review the regulation related to this deficiency and will adhere to it. Proof of correction will be submitted to LPA Lourdes Montoya by the POC due date via email to Lourdes.Montoya@dss.ca.gov.
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On 11/5/2021 at around 10:00 am, LPA Lourdes Montoya and LPM Angela Kendrick observed the facility living room was unkept, unfolded clothes and shoes were scattered on the floor and on the couch; the garage was full of debris including empty water bottles, boxes, white plastic bags and other unseen stuff inside the garage. This poses a potential Health and Safety or Personal Rights risk of residents in care.
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Type B
11/15/2021
Section Cited
CCR
87468.1(a)(2)
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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
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Licensee/Administrator agrees to submit a plan that will ensure clients personal rights are not violated. Proof of correction will be submitted to LPA Lourdes Montoya by the POC due date via email to Lourdes.Montoya@dss.ca.gov.
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On 11/5/2021, LPA Lourdes Montoya and LPM Angela Kendrick smelled a strong incense of marijuana while waiting at the front door of the facility. While both LPA and LPM were touring the facility and condutcting interviews, they observed a strong smell of marijuana was coming out from Residents' (R1-R2) bedroom. Resident (R2), Staff (S2) and Guest (W1) disclosed in an interview that R1 smokes marijuana in his bedroom and around the house. S2 also stated R1 smokes marijuana for pleasure and not for medical purposes.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20211028105238
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754

FACILITY NAME: OATHPARK
FACILITY NUMBER: 197608037
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/09/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/15/2021
Section Cited
CCR
87468.1(a)(11)
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87468.1(a) Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (11) To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. This requirement is not met as evidenced by:
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Licensee/Administrator agreed to review the regulation related to this deficiency and will adhere to it. Self certification will be submitted to LPA Lourdes Montoya by the POC due date.
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Based on LPA Lourdes Montoya's interview with Staff (S2) on 11/5/2021, she admitted she denied entry to the Ombudsman three times out of her four (4) attempted visits based on the administrator’s instructions. S2 explained the administrator does not allow any guest in the facility due to the pandemic. Resident (R2) also stated he is aware that Ombudsman was denied entry to the facility a few times. This poses a potential Health and Safety or Personal Rights risk of residents in care.
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Type B
11/15/2021
Section Cited
CCR
87405(d)(2)
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87405 Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement is not met as evidenced by:
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Licensee/Administrator shall self-certify to review the Title 22 regulations related to deficiencies and ensure to adhere to its provisions. A proof of correction will be submitted to LPA Lourdes Montoya by the POC due date via email to Lourdes.montoya@dss.ca.gov.
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Based on interview with S2 on 11/5/2021, Administrator instructed Staff (S2) to deny entry to Ombudsman due to a pandemic; Resident (R1) smokes marijuana inside the facility for pleasure and no restriction was given. This poses a potential Health and Safety or Personal Rights risk of residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5