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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609904
Report Date: 11/18/2022
Date Signed: 11/18/2022 11:45:37 AM

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., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/13/2020 and conducted by Evaluator Wendell Smith
COMPLAINT CONTROL NUMBER: 31-AS-20201013155156
FACILITY NAME:OAKMONT OF VALENCIAFACILITY NUMBER:
197609904
ADMINISTRATOR:VEIS, MARGIEFACILITY TYPE:
740
ADDRESS:24070 COPPER HILL DRIVETELEPHONE:
(661) 568-6080
CITY:VALENICASTATE: CAZIP CODE:
91354
CAPACITY:0CENSUS: 103DATE:
11/18/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:CYNTIA DRACHENBERGTIME COMPLETED:
11:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility did not contact responsible party
Facility failed to bathe resident
Resident missed medication
Lack of Care and supervision
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced subsequent visit to finish investigation into the allegations above. LPA met with administrator and explained the reason for this visit.
Regarding the allegations previous visits were made on 10/21/2020, 12/13/2021, and 11/14/2020. During the course of those visits interviews were conducted with facility staff. Resident records were also obtained and reviewed. During the course of the investigation this facility was closed as of 9/20/21 and most of the staff that worked with resident #1 (R1) does not currently work for the new facility 197610183 of the same name. LPA attempted to contact the complainant on several different occasions but did not receive any response. Based on the lack of information available there is a lack of evidence to state that any of the allegations above took place. Based on the information obtained these allegations are Unsubstantiated at this time.
Exit Interview conducted and copy of report issued.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell SmithTELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022
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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