197610183-12-2-2024-31-AS-TAGD-DC4MP8-20241219084644

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610183
Report Date: 12/02/2024
Date Signed: 12/02/2024 04:32:06 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
03/21/2023 and conducted by Evaluator Tuesday Cabiness

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20230321145444

FACILITY NAME:	OAKMONT OF VALENCIA		FACILITY NUMBER:	197610183
ADMINISTRATOR:	MYLA BELSON		FACILITY TYPE:	740
ADDRESS:	24070 COPPER HILL DRIVE		TELEPHONE:	(661) 568-6080
CITY:	VALENCIA	STATE: CA	ZIP CODE:	91354
CAPACITY:	144	CENSUS: 104	DATE:	12/02/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Myla Belson		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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1. Resident sustained a fall and injuries while in care
2. Staff failed to seek medical attention for resident in a timely manner
3. Staff left resident unattended for extended periods of time
4. Staff failed to meet reporting requirements
5. Staff failed to protect resident from being harmed by another resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tuesday Cabiness conducted a subsequent visit and met with Executive Director Myla Belson, and informed her the reason of the visit, which was to deliver the final findings of the allegations mentioned above. The following was determined.

Allegation # 1: It was alleged resident sustained a fall and injuries while in care. On 03/29/2023, from 10:30 a.m. to 2:40 p.m., (LPA) conducted the initial investigation, which included interviews, a review of facility and resident records, and a physical plant inspection. During a follow-up visit conducted today from 10:00 a.m. to 2:30 p.m., LPA conducted additional interviews and reviewed resident records. It was reported (R1) had experienced multiple falls at the facility and was assessed as a fall risk. It was reported that (R1) required the use of a walker for ambulation but often needed reminders to use it. Facility records confirmed that staff treated (R1) for a skin tear, notified the Power of Attorney (POA) and primary physician, and facilitated blood work in response to changes in (R1’s) behavior and falls. Although, (R1) did fall and sustained an injury and bruises, LPA determined, the falls were unavoidable due to (R1’s) medical condition and mental state.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024

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-20230321145444

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: OAKMONT OF VALENCIA	FACILITY NUMBER: 197610183
	VISIT DATE: 12/02/2024

NARRATIVE

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Based on interviews and documentation reviewed, there is insufficient evidence to prove the allegation, therefore, it is Unsubstantiated at this time.

Allegation # 2: It was alleged staff failed to seek medical attention for resident in a timely manner. On 03/29/2023, from 10:30 a.m. to 2:40 p.m., (LPA) conducted the initial investigation, which included interviews, a review of facility and resident records, and a physical plant inspection. During a follow-up visit conducted today from 10:00 a.m. to 4:30 p.m., the LPA conducted additional interviews and reviewed resident records. On 03/09/2023, staff discovered( R1) on the bathroom floor following a fall. Staff observed a skin tear near (R1’s) elbow and applied first aid. Staff reported that (R1) did not complain of pain and displayed a full range of motion in both arms and legs. Documentation reviewed by LPA indicated that staff appropriately treated (R1’s) injury and continued to treat and monitor over several days. Documentation also demonstrated that the wounds appeared to be old and healing. Based on documentation and interviews, there is insufficient evidence to support the allegation that staff failed to seek timely medical attention. Therefore, the allegation is Unsubstantiated at this time.

Allegation # 3: It was alleged staff left resident unattended for extended periods of time. On 03/29/2023, from 10:30 a.m. to 2:40 p.m., (LPA) conducted the initial visit, which included interviews, a review of facility and resident records, and a physical plant inspection. During a follow-up visit conducted today from 10:00 a.m. to 2:30 p.m., LPA conducted additional interviews and reviewed facility records. Staff and residents both denied staff leave them unattended for extended periods of time. And LPA does not have enough evidence to prove the allegation, therefore based on interviews, the allegation is Unsubstantiated at this time.

Allegation # 4: It was alleged staff failed to meet reporting requirements. On 03/29/2023, from 10:30 a.m. to 2:40 p.m., the Licensing Program Analyst (LPA) conducted the initial visit, which included interviews, a review of facility and resident records, and a physical plant inspection. During a follow-up visit conducted today from 10:00 a.m. to 4:30 p.m., the LPA conducted additional interviews and reviewed facility records. It was reported that the facility was not submitting incident reports to the Department’s Complaint Intake Unit. LPA determined that the facility is submitting incident reports to the appropriate local regional office via fax or email. A review of the facility’s profile confirmed that incident reports are being submitted in a timely manner

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20230321145444

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: OAKMONT OF VALENCIA	FACILITY NUMBER: 197610183
	VISIT DATE: 12/02/2024

NARRATIVE

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Based on record review, there is insufficient evidence to support the allegation that staff failed to meet reporting requirements. Therefore, the allegation is Unsubstantiated at this time.

Allegation #5: It was alleged that staff failed to protect a resident from being harmed by another resident. On 03/29/2023, from 10:30 a.m. to 2:40 p.m., (LPA) conducted the initial visit, which included interviews, a review of facility and resident records, and a physical plant inspection. During a follow-up visit conducted today from 10:00 a.m. to 4:30 p.m., LPA conducted additional interviews and reviewed facility records. According to the information obtained, (R2) denied pushing (R1), while (R1) was vague about the alleged incident and denied it occurred. There were no witnesses that were identified by (LPA) and staff to confirm the incident. Both (R1) and (R2) are no longer residing at the facility. (R1) was relocated to another facility, and (R2) passed away. Based on interviews and documents reviewed, there is insufficient evidence to support the allegation, therefore it is Unsubstantiated at this time.

Exit interview and copy of report provided to ED.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024

LIC9099 (FAS) - (06/04)

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