<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610183
Report Date: 08/28/2024
Date Signed: 08/28/2024 05:56:17 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
05/06/2022 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20220506153855
FACILITY NAME:OAKMONT OF VALENCIAFACILITY NUMBER:
197610183
ADMINISTRATOR:CYNTIA DRACHENBERGFACILITY TYPE:
740
ADDRESS:24070 COPPER HILL DRIVETELEPHONE:
(661) 568-6080
CITY:VALENCIASTATE: CAZIP CODE:
91354
CAPACITY:144CENSUS: 106DATE:
08/28/2024
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Myla Belson, Administrator TIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not meeting resident's hygiene needs
Resident's room is malodorous
Staff are not providing adequate laundry service to resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At 12:30pm, Licensing Program Analysts (LPA), Angela Panushkina and Perchui Milena Khurshudyan, conducted a subsequent visit to obtain additional information and deliver final report. LPAs met with the Executive Director and explained the reason for the visit.

During the initial visit, conducted on 05/13/2022, LPA Ruiz requested resident and staff roster. LPA Ruiz also conducted an interview with the (former) Executive Director and staff from 10:00am-12:00pm. Three (3) pictures, relevant to allegations, were also obtained/provided. Additionally, LPA Panushkina requested R1’s medical records dated on 01/03/2022.

During today’s visit, LPAs conducted a physical plant tour, to ensure health and safety of the residents are protected. Between 12:50pm - 2:10pm, LPAs interviewed the Executive Director, Culinary-Executive Chef, one (1) MedTech, two (2) staff and six (6) out of ten (10) residents.
Continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
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 7
Control Number 31-AS-20220506153855
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: 08/28/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff are not meeting resident's hygiene needs

It was alleged that R1 is not getting showers and their hair is greasy and dirty. Moreover, it was reported that R1’s shoes, saturated with diarrhea, were found in the cabinet with R1’s toothbrush. To investigate this allegation, LPA Ruiz conducted an interview with the Executive Director and was informed that Tradition 1 has five (5) staff and Tradition 2 has four (4) staff and a weekly schedule with their assignments are being provided to all staff. Additionally, two (2) staff interviewed confirmed that they receive their assignment, and each staff member is assigned to provide care and supervision to no more than 8 residents and all residents are scheduled to have showers at least twice a week or as needed. Although basic services have been provided to R1 (regarding the showers and diaper change), the facility staff failed to clean R1’s shoes, saturated with diarrhea, which was found in the cabinet with R1’s toothbrush (picture attached). Based on LPAs observation and a picture evidence this allegation is Substantiated.

Resident's room is malodorous

During the initial visit conducted by LPA Ruiz on 05/13/22 a physical tour was made with the Executive Director. Upon entry into the Memory Care Unit (Traditions 1) LPA and the Executive Director smelled a strong odor of urine. Moreover, when LPA and the Executive Director toured R1’s room #122B they observed that the toilet was clogged, and the room was malodorous. Interview with the Executive Director revealed that she was not aware of the issue. A maintenance order had been placed immediately. Based on LPAs observation, this allegation is deemed Substantiated.



Staff are not providing adequate laundry service to resident

During the physical plant tour, conducted by LPA Ruiz on 05/13/22, the laundry machines were in working order and laundry services were being provided. However, interviews with the Executive Director and a Memory Care Director revealed that there were having trouble with soap. Staff had reported that soap for laundry was an issue. The facility had already reached out to Eco Lab and complaint of soap leaving stains. Based on interviews and picture evidence this allegation is Substantiated.



Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are cited and noted on LIC9099-D.
Exit interview conducted, appeal rights explained and copy of this report signed and delivered.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 7
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
05/06/2022 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20220506153855

FACILITY NAME:OAKMONT OF VALENCIAFACILITY NUMBER:
197610183
ADMINISTRATOR:CYNTIA DRACHENBERGFACILITY TYPE:
740
ADDRESS:24070 COPPER HILL DRIVETELEPHONE:
(661) 568-6080
CITY:VALENCIASTATE: CAZIP CODE:
91354
CAPACITY:144CENSUS: DATE:
08/28/2024
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:TIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff left resident in soiled diapers for extended period of time
Staff are not providing adequate food service to resident's
Staff are not safeguarding resident's personal belongings.
Resident was severely dehydrated
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At 12:30pm, Licensing Program Analysts (LPA), Angela Panushkina and Perchui Milena Khurshudyan, conducted a subsequent visit to obtain additional information and deliver final report. LPAs met with the Executive Director and explained the reason for the visit.

During the initial visit, conducted on 05/13/2022, LPA Ruiz requested resident and staff roster. LPA Ruiz also conducted an interview with the (former) Executive Director and staff from 10:00am-12:00pm. Three (3) pictures, relevant to allegations, were also obtained/provided. Additionally, LPA Panushkina requested R1’s medical records dated on 01/03/2022.

During today’s visit, LPAs conducted a physical plant tour, to ensure health and safety of the residents are protected. Between 12:50pm - 2:10pm, LPAs interviewed the Executive Director, Culinary-Executive Chef, one (1) MedTech, two (2) staff and six (6) out of ten (10) residents.
Continue on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
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 7
Control Number 31-AS-20220506153855
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: 08/28/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff left resident in soiled diapers for extended period of time

It was alleged that R1 was left in saturated diapers with feces and urine in bed. During the initial visit, conducted by LPA Ruiz, interview with the Executive Director, Memory Care Director and staff were made. At that time, LPA was informed that R1 was diagnosed with Dementia and wore adult diapers due to urinary incontinence. Two (2) staff interviewed denied that R1 was left in soiled diapers for an extended period of time. S1 stated that R1's diaper was constantly changed throughout the day and that R1 was given a bath two (2) times per week. LPA was also informed that all incontinent residents are scheduled to be changed every two hours or as needed. In addition, during today’s visit, LPAs conducted an interview with six (6) out ot ten (10) residents and all residents interviewed expressed no concerns regarding the above allegation. Lastly, during the interviews and physical plant tour, LPAs observed all residents looked clean and well taken care of. Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is Unsubstantiated at this time.

Allegation: Staff are not providing adequate food service to resident's

It was alleged that facility staff failed to provide adequate food service by serving residents food that they can't cut. To investigate this allegation, LPAs conducted an interview with the Culinary Executive Chef and two (2) staff members. All parties interviewed informed LPAs that the facility provides three (3) nutritious meals and snacks in between. Moreover, the Executive Chef informed LPAs that the kitchen area has a board with residents pictures/names that require special diet and the facility always follows doctors orders. In addition, LPAs were informed that protein (chicken, meat, fish) is always being chopped prior to be served to all residents. Two (2) staff interviewed corroborated the Chef's statement and informed LPAs that they always assist Memory Care Unit residents with cutting their meals upon request. Lastly, interview with six (6) out of ten (10) residents expressed no concerns of the food services. Based on the information obtained, there was insufficient evidence to corroborate the allegation of staff not providing an adequate food service to residents. Therefore, the allegation is deemed Unsubstantiated at this time.

Continue on LIC9099-C

SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 31-AS-20220506153855
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: 08/28/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff are not safeguarding resident's personal belongings.

It was alleged that R1's clothes had gone missing. To investigate this allegation, LPA Ruiz conducted an interview with the Executive Director, Memory Care Director and staff, during the initial visit. All parties interviewed denied the above allegation. LPA Ruiz was informed that due to R1's diagnoses, R1 would misplace his/her personal belongings. Nothing has been brought up as missing. LPA was also informed that once the management makes aware of this type of an issue, all staff gets notified and the facility starts a search. Most of the time (95%) the residents misplace their belongings and the staff finds and returns it to them. Six (6) out of ten (10) residents interviewed, during today's visit, expressed no concerns regarding the above allegation. Based on the information obtained this allegation is deemed Unsubstantiated at this time.

Allegation: Resident was severely dehydrated

To investigate this allegation, LPA Ruiz, conducted an interview with the Executive Director and staff during the initial visit. All parties interviewed revealed that they always keep juice and water next to R1’s bed and that R1 was drinking fluids regularly. A review of medical records from the hospital did not reveal any information to verify that at the time of admission to the hospital (in January 2022) R1 was dehydrated. Based on interviews and record reviews, this allegation is deemed Unsubstantiated at this time.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 31-AS-20220506153855
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: 08/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/04/2024
Section Cited
CCR
87468.1(a)(2)
1
2
3
4
5
6
7
Personal Rights of Residents in All Facilities: (a)Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings...
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Administrator will have in-service training with all staff and submit copy of the proof to LPA by POC date.
8
9
10
11
12
13
14
Based on LPA Ruiz inspection, during the initial visit, the licensee did not comply with the section cited above. Staff failed to clean R1’s shoes, saturated with diarrhea, which was found in the cabinet with R1’s toothbrush This poses/posed a potential health and safety risk to persons in care.
8
9
10
11
12
13
14
Type B
09/04/2024
Section Cited
CCR
87625(b)(3)
1
2
3
4
5
6
7
Managed Incontinence: (b) In addition to Section 87611... the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry, and that the facility remains free of odors from incontinence.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Administrator will have in-service training regarding this section. Proof of training will be submitted to LPA by POC date.
8
9
10
11
12
13
14
Based on LPA Ruiz inspection/observation, during the initial visit, licensee did not comply with the section cited above by having a strong odor of feces/urine in room #122B and Memory Care Unit. This poses/posed a potential health and safety risk to persons 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 GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 31-AS-20220506153855
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: 08/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/04/2024
Section Cited
CCR
87307(a)(3)(C)
1
2
3
4
5
6
7
Personal Accommodations & Services:
(a) Living accommodations and grounds shall be... Equipment and supplies necessary for personal care and maintenance of adequate hygiene... (C) Clean linen… shall be in good repair.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Administrator shall conduct an in-service training to housekeeping regarding residents' laundry. Submit copy of training, with staff's signatures, as proof of attendance, to LPA
8
9
10
11
12
13
14
Based on interview/observation conducted by LPA Ruiz, licensee did't comply with the section cited above by purchasing a laundry detergent that damaged residents personal items; clothing, bedsheets, which posed a potential health and safety risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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 GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 7