197610183-3-29-2023-31-AS-NGID-CUPU3R-20230814151355

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610183
Report Date: 03/29/2023
Date Signed: 03/29/2023 03:52:11 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
11/18/2022 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20221118155410

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: 97	DATE:	03/29/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Myla Benson, Executive Director		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Resident sustained multiple falls while in care

INVESTIGATION FINDINGS:

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An unannounced subsequent complaint visit was conducted on this day by licensing program analyst (LPA) Angela Panushkina to issue the findings of the above listed allegation. LPA met with the Executive Director and explained the reason for the visit.

On 11/22/22 LPAs Panushkina and Cava conducted an initial visit and during that visit LPAs interviewed with the Regional Operations Specialist, five (5) out of five (5) staff members, three (3) MedTechs, Chef, one (1) cook, ten (10) out of ten (10) residents and reviewed facility records from 12:00pm to 4:00pm. LPAs also obtained copies of pertinent documents relevant to the investigation.

A similar complaint (#31-AS-20221006103434), regarding the same Resident #1 (R1), was received by the Regional Office (RO) on 10/06/22 and referred to Community Care Licensing Division’s Investigations Branch (IB) on 10/07/22.
Continue on LIC9099-C

Substantiated

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: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

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-20221118155410

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: 03/29/2023

NARRATIVE

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Assigned Investigator, Laarni Santiago, subpoenaed R1’s Medical Records on 10/13/22 and reviewed on 12/23/22. The Investigator's final report was received by RO on 01/13/23.

Allegation: Resident sustained multiple falls while in care

The investigation findings, conducted by the Investigator, Laarni Santiago, revealed that R1 had been living at this facility, in a Memory Care Unit, since April 2021. Interview with R1’s family revealed that R1 continued to have multiple falls from 09/12/22 to 10/26/22 that resulted in bruising and skin tear. Review of medical records confirmed that on 09/12/22, the facility initiated emergency medical services and resident was later diagnosed with a nasal tip fracture after an unwitnessed fall that staff was unable to explain. In addition, on 10/08/2022, family brought R1 for a doctor’s visit due to unexplained bruising and confirmed that R1 sustained three rib fractures. Lastly, R1 continued to have multiple falls that resulted in bruising and skin tear until R1 moved out from Oakmont of Valencia on 10/26/2022, due to hospitalization from another fall. Although, the facility was aware of the R1's decline, yet records verified that there were no updated reappraisals or fall plans in place to reflect on managing the R1’s change of condition. Based on interviews and document review, during the course of the investigation, there is sufficient evidence to conclude that the above allegation is Substantiated.

Exit interview conducted.

Civil penalties assessed and appeal rights explained.

Report reviewed, signed and delivered.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20221118155410

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/29/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type A 03/31/2023 Section Cited CCR 87705(4)	1 2 3 4 5 6 7	Care of Persons with Dementia (4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her current appraisal. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee/Administrator will conduct by-weekly meetings with all staff regarding residents changes (if any). Licenee will also Submit Statement of Understanding, detailing how the facility will maintain compliance of Regulation 87705(4) by POC date to LPA
	8 9 10 11 12 13 14	Basen on the information obtained, by the Investigator, Licensee/Administrator did not comply with the section cited above by knowing R1 needed 1:1 staffing and did not put into current appraisal as the appraisal was never updated, which poses an immediate health and safety risk to residents is care.	8 9 10 11 12 13 14
Request Denied Type A 03/31/2023 Section Cited CCR 87705(c)(5)(A)	1 2 3 4 5 6 7	Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia... (5) Each resident with dementia... A) When any medical assessment... ...corresponding changes shall be made... This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee/Administrator will schedule vendorized training for all staff regarding Regulation 87705(c0(5)(A) Licensee/Administrator will submit the credentials of the trainer with the scheduled training dates by 03/31/2023 and completion of training by 03/31//2023.
	8 9 10 11 12 13 14	Based on the information obtained, by the Investigator, licensee did not comply with the section cited above by failing to provide an updated care plan to address R1's chronic falls, which poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14

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: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

LIC9099 (FAS) - (06/04)

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