197609904-9-3-2022-31-AS-RRAZ-CPSMM2-20230310084309

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609904
Report Date: 09/03/2022
Date Signed: 09/03/2022 03:22:44 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., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/30/2021 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20210730115230

FACILITY NAME:	OAKMONT OF VALENCIA		FACILITY NUMBER:	197609904
ADMINISTRATOR:	VEIS, MARGIE		FACILITY TYPE:	740
ADDRESS:	24070 COPPER HILL DRIVE		TELEPHONE:	(661) 568-6080
CITY:	VALENICA	STATE: CA	ZIP CODE:	91354
CAPACITY:	0	CENSUS: 105	DATE:	09/03/2022
		UNANNOUNCED	TIME BEGAN:	09:13 AM
MET WITH:	Rhonda Bunnin - Memory Care Director		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not administer resident's medication as prescribed

Staff did not seek medical care for resident in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with Memory Care Director Rhonda Bunnin and explained the reason for the visit.

LPA conducted physical plant tour at around 9:40 AM, requested facility documents relevant to the investigation at 10:05 AM, interviewed staff and residents between 10:45 AM to 12:30 PM and reviewed records between 12:30 PM to 2:30 PM. Regarding the allegation that Staff did not administer resident's medication as prescribed, it was alleged that a resident ran out of prescribed medication at the facility because staff did not refill the resident's prescription in a timely manner, resulting to the resident not being administered their prescribed medication for 10-11 days. LPA's interview with Memory Care Director on 08/04/21 at around 1:00 PM and Health Services Director on 08/04/21 at 2:30 PM revealed that there was no resident who had missed any medication at the facility. LPA's record review today at around 11:16 AM revealed that there was no resident missed any medication. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2022

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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Control Number 31-AS-20210730115230

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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: OAKMONT OF VALENCIA	FACILITY NUMBER: 197609904
	VISIT DATE: 09/03/2022

NARRATIVE

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(continued from LIC 9099)

LPA's interview with eight (8) residents on 08/04/21 between 12:00 PM to 2:30 PM also revealed that six (6) out of six (6) residents did not miss medication and two (2) of them managed their own medication.

During the course of the investigation, LPA was not able to reach the reporting party (RP) to get more details on each allegation because RP did not provide any contact including phone, physical and/or email address. RP also did not provide any identifier of any resident who may be the subject of the complaint nor any witness or staff who may have the knowledge of the allegation.

Regarding the allegation that Staff did not seek medical care for resident in a timely manner, it was alleged that a resident had an infected toe but staff did not seek medical attention for the resident. LPA's interview with Health Services Director on 08/04/21 at 2:30 PM revealed that there was only one resident hospitalized due to toe infection. LPA's record review today at 1:35 PM revealed that Resident #1 (R1) was brought to the hospital on the same day by own family member upon being informed by and encouragement of the facility staff on 05/16/21 regarding R1's toes. Further, R1 had been on home health services care since 03/10/21.

Based on the information gathered during this and prior visits, there is insufficient information to support the allegations and therefore deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2022

LIC9099 (FAS) - (06/04)

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