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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610183
Report Date: 09/17/2022
Date Signed: 09/17/2022 03:01:53 PM

Unsubstantiated


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
01/03/2022 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20220103144127
FACILITY NAME:OAKMONT OF VALENCIAFACILITY NUMBER:
197610183
ADMINISTRATOR:FUNDERBERG, STEPHANIEFACILITY TYPE:
740
ADDRESS:24070 COPPER HILL DRIVETELEPHONE:
(661) 568-6080
CITY:VALENCIASTATE: CAZIP CODE:
91354
CAPACITY:144CENSUS: 103DATE:
09/17/2022
UNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Cinthya Drachenberg, Executive Director TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Resident's room has fecal smears.
Resident's 240 room is odoriferous.
INVESTIGATION FINDINGS:
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At 9:00am Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced subsequent complaint visit to deliver the finings for the above stated allegations. LPA met with the Executive Director and explained the reason for the visit.

LPA conducted physical plant tour around 9:20am and requested facility documents relevant to the investigation. LPA interviewed staff between 10:30am – 1:00pm and reviewed facility records 1:00pm to 2:30pm. LPA also visited rooms for five randomly chosen residents in a Memory Care Unit. During LPA’s tour, the facility and randomly chosen 5 resident’s room appeared clean and smelled fresh. Interviews with
four (4) staff members revealed that the facility housekeeper is scheduled to clean four to five rooms per day, including the hallway, on Monday and Saturday from (6:00am-3:00pm). All staff members informed LPA that cleaning is done - daily and they had not received any complaint regarding the above mentioned allegations.
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: 09/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2022
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 2
Control Number 31-AS-20220103144127
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: 09/17/2022
NARRATIVE
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Based on the information obtained through interviews, record reviews and LPA’s observation both allegations are deemed Unsubstantiated at this time.

Exit inter interview conducted and copy of this report provided to the Executive Director.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2