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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610183
Report Date: 09/14/2022
Date Signed: 09/14/2022 03:37:19 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
08/23/2022 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20220823163149
FACILITY NAME:OAKMONT OF VALENCIAFACILITY NUMBER:
197610183
ADMINISTRATOR:CYNTIA DRACHENBERGFACILITY TYPE:
740
ADDRESS:24070 COPPER HILL DRIVETELEPHONE:
(661) 568-6080
CITY:VALENCIASTATE: CAZIP CODE:
91354
CAPACITY:144CENSUS: 103DATE:
09/14/2022
UNANNOUNCEDTIME BEGAN:
10:36 AM
MET WITH:Cynthia Drachenberg, Executive Director. TIME COMPLETED:
11:20 PM
ALLEGATION(S):
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Staff did not prevent a resident from physically abusing another residents
INVESTIGATION FINDINGS:
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At 10:35am, Licensing Program Analyst (LPA) Angela Panushkina made an unannounced subsequent visit to finish investigation into the allegation above. LPA met with an Executive Director and explained the reason for the visit. It is alleged that Staff did not prevent a resident from physically abusing another resident.

LPA made the initial complaint visit on 09/01/2022. On that day LPA conducted interviews with the Executive Director, Memory Care Director, MedTech, Activity Coordinator, Activity Assistant, 3 out of 3 staff, 2 out of 2 residents and reviewed facility records. LPA also obtained copies of pertinent documents relevant to the investigation.

During the initial visit to Oakmont of Valencia Memory Care Unit (Traditions 2), LPA was unable to identify any resident witnesses. Interviews with an Executive Director, Memory Care Director, MedTech, Activity Coordinator, Activity Assistant and three (3) staff members revealed that there was no abuse between
Continue on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022
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 2
Control Number 31-AS-20220823163149
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: 197610183
VISIT DATE: 09/14/2022
NARRATIVE
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resident to resident. It was resident #1 (R1) being aggressive and abusive towards the staff members.

Based on information obtained through interviews and document review this allegation is deemed Unsubstantiated.

Exit interview conducted and copy of report was provided to Administrator.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022
LIC9099 (FAS) - (06/04)
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