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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610183
Report Date: 05/08/2025
Date Signed: 05/08/2025 01:10:18 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
02/21/2024 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20240221150503
FACILITY NAME:OAKMONT OF VALENCIAFACILITY NUMBER:
197610183
ADMINISTRATOR:MYLA BELSONFACILITY TYPE:
740
ADDRESS:24070 COPPER HILL DRIVETELEPHONE:
(661) 568-6080
CITY:VALENCIASTATE: CAZIP CODE:
91354
CAPACITY:144CENSUS: 103DATE:
05/08/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Myla Belson TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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1. Due to lack of staff, residents are not changed timely
2. Due to lack of staff, residents are not getting assistance timely
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuesday Cabiness conducted a subsequent visit, to deliver the final findings of the allegations mentioned above. LPA met with Excecutive Director Myla Belson and informed her the reason of the visit. The following was determined:


Allegation # 1: It was alleged that, due to a lack of staff, residents were not changed in a timely manner. To investigate the allegation, (LPA) conducted interviews and reviewed facility and resident records, as well as other relevant documentation, on the following dates: July 23, 2023; February 29, 2024; December 3, 2024; February 6, 2025; April 24, 2025; and May 8, 2025, between 9:45 a.m. and 3:30 p.m. It was specifically alleged that staff allowed Resident #1 (R1) to remain in urine and feces for a period of time. However, during interviews, residents who require incontinence care reported that staff generally respond to their needs in a timely manner and that they do not have to wait long for assistance. Although some staffing concerns were mentioned, LPA observed adequate staffing levels during each site visit.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
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 5
Control Number 31-AS-20240221150503
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: 05/08/2025
NARRATIVE
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Based on interviews, observations, and a review of documentation, there is insufficient evidence to support the allegation that residents were not changed in a timely manner due to staffing shortages. Therefore, the allegation is Unsubstantiated at this time.

Allegation # 2: It was alleged that, due to a lack of staff, residents were not receiving timely assistance. To investigate this allegation, (LPA) conducted interviews and reviewed facility and resident records, as well as other relevant documentation, on the following dates: July 23, 2023; February 29, 2024; December 3, 2024; February 6, 2025; April 24, 2025; and May 8, 2025, between 9:45 a.m. and 3:30 p.m. It was specifically alleged that Resident #1 (R1) was found hanging off the side of the bed without their oxygen mask, and due to staffing issues, R1 did not receive timely assistance, resulting in low oxygen levels. It was also alleged that staff were not aware that R1 had returned to the facility following a hospital discharge. However, it was reported to LPA that the area where R1 resides is secured and requires staff to input an emergency key code to open the door, indicating that staff were aware of R1’s return to the facility. Additionally,interviews revealed that R1 was known to frequently touch their face or move around in bed, which often caused the oxygen mask to become displaced. Staff were aware of this behavior and reported performing routine checks to ensure the mask was properly positioned. Although some concerns regarding staffing were mentioned during interviews, LPA observed adequate staffing levels during each visit. Based on interviews, observations, and a review of facility records, there is insufficient evidence to support the allegation that residents, including R1, were not receiving timely assistance due to staffing shortages. Therefore, the allegation is Unsubstantiated at this time.

Exit interview and copy of report provided.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
02/21/2024 and conducted by Evaluator Tuesday Cabiness
COMPLAINT CONTROL NUMBER: 31-AS-20240221150503

FACILITY NAME:OAKMONT OF VALENCIAFACILITY NUMBER:
197610183
ADMINISTRATOR:MYLA BELSONFACILITY TYPE:
740
ADDRESS:24070 COPPER HILL DRIVETELEPHONE:
(661) 568-6080
CITY:VALENCIASTATE: CAZIP CODE:
91354
CAPACITY:144CENSUS: 103DATE:
05/08/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Myla Belson TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff do not give medications as prescribed
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuesday Cabiness conducted a subsequent visit, to deliver the final finding of the allegation mentioned above. LPA met with Excecutive Director Myla Belson and informed her the reason of the visit. The following was determined:

It was alleged that staff do not administer medications as prescribed. To investigate the complaint, (LPA) conducted interviews and reviewed facility, resident records, and other documentation related to the allegation on the following dates: February 29, 2024; December 3, 2024; February 6, 2025, April 24, 2025, and during today’s visit, between 9:45 a.m. and 3:30 p.m. According to the information obtained, the facility submitted a Special Incident Report (SIR) to the Department, indicating that Resident #1 (R1) was not administered one dose of their prescribed inhaler. The facility conducted its own internal investigation and confirmed that the dose was missed. Based on documentation and interviews, the allegation is Substantiated. This is a immediate health and safety risk to residents in care.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 31-AS-20240221150503
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: 05/08/2025
NARRATIVE
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Citation issued, civil penalty assessed, appeal rights, and copy of report provided. Plan of correction is cleared, due to facility recent medication training conducted by credential training from the Allen Flores Group on April 8 and 9, 2025.

Exit interview conducted.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20240221150503
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/08/2025
Section Cited
CCR
87465(c)(2)
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Incidental Medical and Dental Care:If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff...shall be permitted to assist...
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POC cleared..Staff received medication training by credential agency, the Allen Flores group on April 8 and 9, 2025.
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(2) Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met, evidenced by, based on the SIR, (R1) was not giving inhaler according to doctor's orders. This is an immediate health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5