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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610183
Report Date: 06/15/2023
Date Signed: 03/20/2024 05:20:37 PM

Document Has Been Signed on 03/20/2024 05:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 VALENCIAFACILITY NUMBER:
197610183
ADMINISTRATOR:MYLA BELSONFACILITY TYPE:
740
ADDRESS:24070 COPPER HILL DRIVETELEPHONE:
(661) 568-6080
CITY:VALENCIASTATE: CAZIP CODE:
91354
CAPACITY: 144CENSUS: 97DATE:
06/15/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Myla BensonTIME COMPLETED:
02:15 PM
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This is an Amendment to the original report, issued on 06/15/23, the Licensee has appealed the deficiency and it has been granted, therefore, the deficiency will be dismissed from LIC809-D page.

On 6/15/23, LPA arrived at the facility to conduct an initial complaint investigation. This Case Management – Incident report is being done in conjunction with Complaint Control # 31-AS-20230608081726. LPA conducted record review from 11:00 a.m. – 12:00 p.m. to address allegations on complaint control number mentioned above. During records review, LPA reviewed incident report dated 2/10/23, where R1 reported to staff that R2 had tried to rape them. At approximately 11:30 a.m., the Executive Director stated this was an incident that had been alleged by R1, but they could not confirm it happened. An incident report was submitted to CCL along with a SOC341,and it was reported that overnight staff found R2 in R1’s bedroom, both in their undergarments and R2 was escorted back to their bedroom. Incident report stated that in service training was done on “staff locking resident doors overnight” and increased status checks. LPA reviewed R2's updated ISP, and no plan or notes were written for sexual behaviors.

Due to the lack of information and plan to address R2's behaviors, deficiency issued per CA Code of Regulations, Title 22. Appeal rights issued. Report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/20/2024 05:21 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 03/20/2024 11:19 AM


Created By: Angela Panushkina On 06/15/2023 at 12:50 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 06/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
06/15/2023
Section Cited
CCR
00000

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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.
SUPERVISOR'S NAME:Nichelle Gillyard
LICENSING EVALUATOR NAME:Angela Panushkina
LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2024


LIC809 (FAS) - (06/04)
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