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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610183
Report Date: 09/29/2026
Date Signed: 09/30/2026 04:45:31 PM

Document Has Been Signed on 09/30/2026 04:45 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/
DIRECTOR:		ASSAAD ZEIDFACILITY TYPE:
740
ADDRESS:24070 COPPER HILL DRIVETELEPHONE:
(661) 568-6080
CITY:VALENCIASTATE: CAZIP CODE:
91354
CAPACITY: 144CENSUS: 104DATE:
09/29/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Mike Gonzalez, Health Services Director TIME VISIT/
INSPECTION COMPLETED:
05:15 PM
NARRATIVE
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This is an Amendment to the original report issued 09/29/2026. Additional information was added to clarify the investigation.

At 10:45am, Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced Case Management visit regarding a reported incident. LPA met with the Administrator/Executive Director and explained the purpose of the visit.

LPA requested resident and staff roster. At approximately 10:55am, requested copies of pertinent information which include, but not limited to Admission Agreement, Physician's Report, Appraisal Needs and Services Plan, Centrally Stored Medication and Destruction Record (CSMDR), Medication Administration Record (MAR), Medication Policy, Staff Training, etc., relevant to the investigation. At approximately 11:20am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected. Between 11:30am - 4:00pm, LPA conducted an interview with the Administrator, Health Services Director, Licensed Vocational Nurse (LVN) / Wellness Nurse and three (3) MedTechs.



Interview with the Administrator revealed that on 09/25/26 MedTech #1 (MT1) was still in training and was shadowed by the facility's LVN. Approximately at 9:15am, seven (7) medications were given to R1 intended for R2. The Administrator promptly notified R1’s Power of Attorney (POA). Once R1’s POA arrived at the facility she/he requested 911 to be called. Around 10:30am, R1 was taken to the hospital. R1 was monitored, underwent lab testing, and was discharged back to the facility at approximately 1:30pm. The facility immediately removed MT1 and LVN from their position and conducted additional training. LPA obtained copies of the training during today’s visit. Continue on LIC809-C
Nichelle Gillyard
Angela Panushkina
DATE: 09/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
VISIT DATE: 09/29/2026
NARRATIVE
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LPA conducted review of R1’s incident report and observed the following: “...Upon discovering the event, Wellness Nurse assessed R1, notified Health Service Director and the Administrator. Executive Director called POA and asked if he/she would like the facility to call 911. POA came to the community; upon arrival he/she asked the Executive Director to call 911.” Based on interviews and documents review, the facility did not follow R1’s physician orders for medication administration, resulting in R1 receiving seven (7) medications intended for R2. The facility also failed to adhere to its own Oakmont of Valencia’s Residence and Services Agreement Section #7 “Security, Emergency Response and Fire Protection” (pg. 3) where it indicates the following: “Our staff are trained to call 911 if an injury or other circumstance results in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis.” Additionally, Provider Information Notice (PIN) Summary (25-06-ASC) that came out in June 24, 2025 indicated the following: "To ensure resident safety, licensees as a best practice should immediately call 9-1-1 if a resident is experiencing any of the following symptoms/conditions listed below..."

Deficiency issued on LIC809-D during today's visit.

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

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Angela Panushkina
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/30/2026 04:46 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 09/30/2026 10:38 AM


Created By: Angela Panushkina On 09/29/2026 at 05:06 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: 09/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/02/2026
Section Cited
CCR
87465(g)

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Incidental Medical and Dental Care: (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical...
This requirement was not met as evidence by:
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Administrator agreed to conduct in-service training with all staff regarding this Section. Copies of training will be submitted to LPA by POC date.
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Based on the investigation, licensee did not comply with the section cited above, by failing to follow facilites Admission Agreement and immediately call 911 when 7 (wrong) medications were given to R1. This posed/poses an immediate health and safety risk to residents in care.
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Type A
10/02/2026
Section Cited
CCR87465(c)(2)

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Incidental Medical and Dental Care:
(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need … (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidence by:
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Administrator informed LPA that all MedTechs completed additional training on 09/27/26. Additionally, Licensee / Administrator will schedule vendorized training for all staff by 10/02/26 and submit to CCL the vendor information and scheduled date of training.
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Based on interviews an record reviews, the licensee did not comply with the section cited above by failing to administer R1's medications as prescribed. Seven (7) medications were given to R1 intended for R2
This posed/poses an immediate health and safety risk to residents in care.
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Training certifications to be submitted to CCL upon completion.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
NAME OF LICENSING PROGRAM MANAGER:
Angela Panushkina
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2026


LIC809 (FAS) - (06/04)
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