197610183-9-28-2022-31-AS-RRAZ-CKTU9R-20221103152331

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610183
Report Date: 09/28/2022
Date Signed: 09/28/2022 04:40:58 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
08/05/2022 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20220805133307

FACILITY NAME:	OAKMONT OF VALENCIA		FACILITY NUMBER:	197610183
ADMINISTRATOR:	CYNTIA DRACHENBERG		FACILITY TYPE:	740
ADDRESS:	24070 COPPER HILL DRIVE		TELEPHONE:	(661) 568-6080
CITY:	VALENCIA	STATE: CA	ZIP CODE:	91354
CAPACITY:	144	CENSUS: 102	DATE:	09/28/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Cyntia Drachenberg, Executive Director		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff dispensed wrong medications not prescribed to resident
Staff falsified resident medication logs

INVESTIGATION FINDINGS:

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At 10:00am Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced subsequent complaint visit to deliver the finings for the above stated allegations. LPA met with the Administrator and explained the reason for the visit.

During the visit made on 09/14/22, LPA Panushkina spoke with the Administrator and three (3) out of three (3) MedTech’s. LPA also reviewed the facility Centrally Stored Medication and Destruction Records (CSMDR) of random residents receiving medication assistance by the facility staff. Upon review of the medications LPA observed that three (3) out of three (3) randomly chosen prescribed medications were centrally stored by the facility. LPA also observed that each resident has an individual, labeled basket for their medications. Interviews with three (3) MedTech’s revealed that they dispense medications for one resident at a time. All MedTech’s informed LPA that once resident takes the medication, MedTech initials the Medication Administration Record (MAR) log. LPA was also informed that when the resident refuses to take the
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: 09/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

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-20220805133307

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: 09/28/2022

NARRATIVE

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medication the staff member writes a comment/reason in MAR log as to why the medication was not taken. Based on review of the facility medication records for the months of July, August and September 2022, for three (3) out of three (3) residents, 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, there is not enough substantial evidence or witnesses to concur with the allegations. Therefore, both allegations are deemed to be Unsubstantiated at this time.

Exit interview conducted and copy of this report provided to the Executive Director.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

LIC9099 (FAS) - (06/04)

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