197610183-2-2-2022-31-AS-NGID-CF5UVU-20220606155543

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610183
Report Date: 02/02/2022
Date Signed: 02/02/2022 04:39:54 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
01/24/2022 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20220124163550

FACILITY NAME:	OAKMONT OF VALENCIA		FACILITY NUMBER:	197610183
ADMINISTRATOR:	FUNDERBERG, STEPHANIE		FACILITY TYPE:	740
ADDRESS:	24070 COPPER HILL DRIVE		TELEPHONE:	(661) 568-6080
CITY:	VALENCIA	STATE: CA	ZIP CODE:	91354
CAPACITY:	144	CENSUS: 90	DATE:	02/02/2022
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Tom Park, Administrator		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

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Insufficient staffing
Facility failed to provide activities for the residents
Facility staff failed to meet residents’ hygiene needs
Facility staff failed to provide adequate food service
Facility staff failed to provide a safe and comfortable environment
Facility staff are not taking any precautions for COVID-19

INVESTIGATION FINDINGS:

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At 9:15am Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced complaint visit to this facility to investigate the allegations mentioned above. LPA was greeted by a staff member and screened for COVID-19. LPA was later greeted by the Executive Director, Tom Park. The purpose of this visit was explained.

At 9:40am LPA requested LIC500 and room roster, weekly menue and an activity calendar.

Allegation: Insufficient staffing.
LPA conducted a tour and interviewed a sample of 11 residents from 10:45am to 1:00pm .
During tour LPA randomly tested a resident’s pendant.

LPA conducted sample interviews of (3) caregivers, Regional Memory Care Specialist, LVN, Activity Coordinator and Executive Director. Continue on LIC 9099-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: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

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 3

Control Number 31-AS-20220124163550

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: 02/02/2022

NARRATIVE

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After review of the information received the allegation, Insufficient staffing is unsubstantiated at this time. Interviews with 9 out of 11 residents, who are able to communicate, indicated that staff are meeting their needs within a timely manner and are happy with service.

LPA conducted a random inspection of the pendant at 11:51 am, staff responded within a reasonable time at 11:59 am. The facilities expectation for response time is 15 min.

Interviews with 2 out of 3 staff indicate that there is sufficient staffing to meet the needs of the resident’s timely due to their communication with each other. Two (2) out of three (3) staff indicate that there is a staffing issue when someone calls in sick, however a manager will step in the position of caregiver to assist and help staff. Interview also indicated that the MedTech will step to assist caregivers as needed.

Allegation: Facility failed to provide activities for the residents.

It is alleged that there are no activities offered by the facility. LPA conducted interviews with 9 out of 11 residents, who are able to communicate, and 3 staff members. Information from interviews revealed that since the onset of Covid-19 the facility does not offer as many activities due to wanting to social distance and keep residents safe. Interviews with residents did show that the facility still conducts bingo, exercise, coloring, music, ect. During todays visit, facility hired a pianist and at 12:40pm LPA observed 25 residents from Memory Care Unit were engaged in singing, dancing and listening to a music. Based on the information obtained through interviews and observation this allegation is deemed Unsubstantiated at this time.

Allegation: Facility staff failed to meet residents’ hygiene needs.
LPA interviewed 9 out of 11 residents, who are able to communicate, and was informed that facility staff always takes good care of them (pull-ups being changed every 2 hours or as needed, showers are being provided twice weekly or as needed). LPA observed all residents wearing clean clothes, smelled good and being well groomed. LPA also observed the entire facility being clean and free from odor. Based on the information obtained through interviews and observation this allegation is deemed Unsubstantiated at this time.

Allegation: Facility staff failed to provide adequate food service
Regarding the allegation that staff are not providing residents with food of good quality, LPA interview with nine (9) residents, who were able to communicate, and revealed that nine (9) residents believe that the quality of the food being served at the facility is okay or good. 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: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20220124163550

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: 02/02/2022

NARRATIVE

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LPA record review and observation also revealed that the facility provides complete meal with fruit and vegetable servings on every meal and staff interview reveals that kitchen staff also customize food being served upon resident's request. Moreover, LPA was informed that the weekly menu may vary and daily menu provides options and alternate option for the residents to choose. Based on the information gathered during this visit, this allegations is deemed unsubstantiated at this time.

Allegation: Facility staff failed to provide a safe and comfortable environment
LPA interviewed three (3) staff members, Regional Memory Care Specialist, LVN, Activity Coordinator and Executive Director. LPA was informed that Memory Care Unit residents were wondering out of their room during the COVID outbreak and the facility staff followed COVID protocols and re-directed them back into their rooms. Based on the information obtained, the allegation is deemed unsubstantiated at this time.

Allegation: Facility staff are not taking any precautions for COVID-19
It was alleged that the facility staff are not taking any precautions for COVID-19 and are not practicing social distancing. LPA conducted a physical plant tour on this 02/02/22 and observed signs throughout the facility promoting mask wearing and social distancing. LPA also observed staff wearing masks throughout the facility. Based on LPA observations, the facility takes adequate precautions for COVID-19.
Based on information obtained, the allegation is deemed unsubstantiated at this time.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

LIC9099 (FAS) - (06/04)

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