197609904-4-29-2021-31-AS-EMIR-CJ4NAE-20220909101721

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609904
Report Date: 04/29/2021
Date Signed: 04/29/2021 12:28:54 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, 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
04/13/2021 and conducted by Evaluator Patrick Shanahan

COMPLAINT CONTROL NUMBER: 31-AS-20210413103102

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:	144	CENSUS: 73	DATE:	04/29/2021
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Stephanie Funderburg		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Facility is in disrepair.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility and was greeted by facility staff. LPA explained the reason for the visit and was able to begin touring the facility at about 9:25 am.

While inspecting all common area bathrooms, LPA observed at 9:45am that one guest/staff bathroom on the first floor was not operating properly. The door was observed to be unaligned with the door frame and would not close or lock. Staff and residents indicated that the bathroom has not been functional for over a week.

Based on interviews and LPA observation, this allegation is deemed to be substantiated at this time. Exit interview conducted, deficiencies cited and report issued.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick Shanahan	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021

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 4

Control Number 31-AS-20210413103102

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/29/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type B 05/05/2021 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	Maintenance and Operation: 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.	1 2 3 4 5 6 7	Administrator agrees to have the door repaired. A photograph and/or work order will be submitter to LPA as POC.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Based on LPA and administrator observation, the licensee did not ensure that the door to the bathroom closes properly, which poses a potential risk to the health and safety of residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick Shanahan	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
04/13/2021 and conducted by Evaluator Patrick Shanahan

COMPLAINT CONTROL NUMBER: 31-AS-20210413103102

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:	144	CENSUS: 73	DATE:	04/29/2021
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Stephanie Funderburg/ Administrator		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Resident's are not fed an adequate amount of food.

Facility did not post Ombudsman poster.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility and was greeted by facility staff. LPA explained the reason for the visit and was able to begin touring the facility at about 9:25 am.
Allegation 1. Resident's are not fed an adequate amount of food
LPA was able to tour the facility and interview staff and residents regarding this allegation. At 10 A.m., LPA was able to tour the facility kitchen and dining room. The kitchen was observed to have a well stocked pantry, refrigerator, and freezer. Staff and residents confirmed that there is enough food for them and that no one is hungry. Staff and residents also stated that the bistro areas are now open and residents can get snacks and drinks from the bistro 24 hours a day. At 10:45 AM., LPA was able to receive copies weight records of 10 random residents. The weight records did not indicate substantial weight loss in any of the residents.
Based on staff and resident interviews, weight record review and LPA observation of the food supply, this allegation is deemed to be unsubstantiated at this time.
Cont. on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick Shanahan	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 31-AS-20210413103102

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: 04/29/2021

NARRATIVE

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Allegation 2. Facility did not post Ombudsman poster.

LPA was able to tour the facility and to speak to staff and residents regarding this allegation. While conducting a tour of the common areas, LPA was able to observe the ombudsman's poster prominently posted in a frame in the Activity room at 9:30 AM. All licensing posters were also observed to be posted and framed in the activity room.

Based on LPA observation, this allegation is deemed to be unsubstantiated at this time. Exit interview conducted and report issued.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick Shanahan	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021

LIC9099 (FAS) - (06/04)

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