197609904-5-14-2021-31-AS-MVAO-CKTRKQ-20221103130553

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609904
Report Date: 05/14/2021
Date Signed: 05/14/2021 04:07:30 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
05/05/2021 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20210505141954

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:	05/14/2021
		UNANNOUNCED	TIME BEGAN:	09:08 AM
MET WITH:	Stephanie Funderburg - Executive Director		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Hot water heater in facility is broken

Facility is not disposing of waste properly

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced initial complaint visit to this facility to investigate the above allegations. LPA met with Executive Director (ED) Stephanie Funderburg and explained the reason for the visit.

LPA conducted physical plant tour with the Maintenance Director at around 10:00 AM. LPA interviewed staff, ED and residents at around 11:45 AM. LPA also requested pertinent documents relevant to the investigation. Regarding the allegation that the hot water in the facility is broken, LPA observed that the facility had five (5) water heaters and three (3) pumps to distribute the hot water to the entire facility with each water heater backing up one another. LPA interview with the maintenance director revealed that immediately after it was reported on the night of 04/17/21, a plumber was called to investigate the next day. The plumber pointed out that the problem was the water heater. The water heater personnel was called and came in on 04/20/21 only to point out that the water heaters were all working so the plumbers were called again to further investigate and found that the problem were the pump wherein they found that only one (1) was working.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021

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-20210505141954

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: 05/14/2021

NARRATIVE

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(continued from LIC 9099)

LPA record review revealed that the service order was placed on 04/21/21 to replace the two(2) water pumps because the other one was still working. The two (2) pumps were replaced on 04/22/21 and the remaining one was replaced the next day (04/23/21) to a newer model to ensure continuity of function. LPA observed during the visit that all the water heater were working and also measured random resident bathrooms water temperature both on the Assisted Living and Memory Care units and measured at a range of 108.3°F to 113.9°F.

Regarding the allegation that the facility is not disposing of waste properly, LPA interview with four (4) care staff revealed that it is part of their routine to pick up the trash in the residents' room and throw it in the big trash can inside the laundry room and then throw them out to the big trash bins at the end of every shift, where it is collected twice a week. LPA interview with the Maintenance Director and Resident Care Services Director confirmed that the trash were being disposed of properly from the residents' room to the waste bin outside of the facility.

Based on the information gathered during this visit, the allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021

LIC9099 (FAS) - (06/04)

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