197609904-3-20-2024-31-AS-MVAO-D4DUSQ-20240416155043

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609904
Report Date: 03/20/2024
Date Signed: 03/20/2024 05:56:10 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
09/14/2021 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20210914140006

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: 96	DATE:	03/20/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Myla Belson, Executive Director		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff were over medicating a resident
Facility staff did not safe guard a resident's property
Facility is not communicating with resident's representative

INVESTIGATION FINDINGS:

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At 10:00am, Licensing Program Analyst (LPA) Angela Panushkina a subsequent visit to deliver final findings. LPA met with the Executive Director, Myla Belson, and explained the reason for the visit.

During the initial visit made on 09/15/21, by LPAs Panushkina and Ruiz, interviews and record reviews were made. At 10:30am, LPAs requested resident and staff roster. LPAs also requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, etc. relevant to the investigation. A physical plant tour was also conducted, to ensure health and safety of the residents are protected and physical plant. LPAs also conducted interviewes with the Executive Director, two (2) staff members and eight (8) residents.

Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

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-20210914140006

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: 03/20/2024

NARRATIVE

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Allegation: Staff were over medicating a resident

It was alleged that the facility the facility staff mislabeled the medication AM/PM and over medicated R1. During the initial visit conducted on 09/21/21, LPAs inspected R1's Centrally Stored Medication and Destruction Record (CSMDR) and Medication Administration Record (MAR) log. Upon review of the medications LPAs observed that R1 had an individual, labeled basket and all prescribed and PRN medications were registered in CSMDR. All documents appeared to be completed to its entirety including medication name, strength, instruction control, date filled, etc. Based on the interviews conducted and documentation reviewed, this allegation is deemed Unsubstantiated at this time.

Allegation: Facility staff did not safe guard a resident's property

It was alleged that the facility residents personal belongings had gone missing/stolen. Interview with the Executive Director revealed that once the resident/representative/family notify the facility staff and or the management about any missing items, the facility staff starts the search and once the missing item is located, it's delivered/retuned to the owner. Interview with two (2) staff members revealed that due to some residents' mental condition in a Memory Care Unit, personal items are often being misplaced. However, the staff is always able to locate and return the item to the resident.

During today's visit, LPA conducted an additional interview with five (5) out of nine (9) residents and all residents interviewed, did not express any concern regarding the above allegation. Based on interviews, this allegation is deemed Unsubstantiated at this time.

Allegation: Facility is not communicating with resident's representative

To investigate this allegation, during the initial visit, LPAs conducted an interview with the Executive Director and were informed that all changes in a resident condition or COVID regulations/restictions are always being communicated with the Resident/POA/Conservator/Family. Interview with six (6) out of eight (8) residents expressed no concerns regarding the above allegation.
Continue on LIC9099-C

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20210914140006

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: 03/20/2024

NARRATIVE

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Moreover, during today's visit, LPA conducted additional interview with five (5) out of nine (9) residents and all residents interviewed informed LPA that the facility always communicates with their families and all five (5) residents expressed no concerns regarding this allegation. Based on interviews, this allegation is deemed Unsubstantiated at this time.

No deficiency cited.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

LIC9099 (FAS) - (06/04)

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