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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610183
Report Date: 09/28/2022
Date Signed: 09/28/2022 04:44:41 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
07/21/2022 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20220721103906
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: 102DATE:
09/28/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Cyntia Drachenberg, Executive Director TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Residents pull cords are in disrepair
Staff do not respond to residents call buttons timely
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced subsequent complaint visit to deliver the finings for the above stated allegations. LPA met with Executive Director, Cyntia Drachenberg, and explained the reason for the visit. Entrance interview conducted.

During the initial 10-day complaint visit conducted on 07/27/22, LPA Panushkina interviewed Executive Director, Activity Coordinator, MedTech, 4 out of 4 staff, 10 out of 10 residents and reviewed facility records. LPA also obtained copies of pertinent documents relevant to the investigation.

Also, during the initial visit, while interviewing a sample of 10 residents, LPA randomly tested resident’s pendant and emergency pull cords in the bathrooms.

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: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
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 5
Control Number 31-AS-20220721103906
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: 09/28/2022
NARRATIVE
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During the initial visit made on 07/27/22, LPA conducted a random inspection of one (1) pendant and three (3) emergency pull cords in the bathrooms, at Assisted Living (AL) Unit, and staff responded within a reasonable time. The facility’s expectation for response time is 10 minutes. However, a random inspection of one (1) resident’s pendant and four (4) emergency pull cords, in the bathroom, at the Memory Care Unit (Traditions 1 and Traditions 2) discovered that none of the five (5) emergency call buttons were operational. Interview with the Executive Director confirmed that the facility was aware of residents pull cords being in disrepair (in Memory Care Unit) as of July 5th, 2022 and that the facility’s Maintenance Director placed an order for new batteries as of 07/21/22. Based on LPA's observation and review of the information received, allegations Residents pull cords are in disrepair AND Staff do not respond to residents call buttons timely, are substantiated at this time.

Deficiencies issued per Title 22.

Exit interview conducted appeal rights explained 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: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 31-AS-20220721103906
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: 09/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/05/2022
Section Cited
CCR
87303(a)(2)
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(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 and equipment.

This requirement is not met as evidenced by:
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Licensee/Administrator placed an order for repairs on 07/22/22. During 09/01/22 visit LPA tested three emergency cord devices in rooms #135, #144 and #147 and observed all three emergency cord devices were in good condition during visit. POC cleared during visit.
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Based on LPAs observation during the visit made on 07/27/22 the licensee did not comply with the section cited above. Resident’s pendant and/or emergency cord devices in both Memory Care Units were in poor repair and non-operational, which poses a potential health and safety risk to persons 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.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
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
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
07/21/2022 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20220721103906

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: 102DATE:
09/28/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Cyntia Drachenberg, Executive Director TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility staff are not ensuring visitors are wearing masks
Residents are not being showered timely
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced subsequent complaint visit to deliver the finings for the above stated allegations. LPA met with Executive Director, Cyntia Drachenberg, and explained the reason for the visit. Entrance interview conducted.

During the initial 10-day complaint visit conducted on 07/27/22, LPA Panushkina interviewed Executive Director, Activity Coordinator, MedTech, 4 out of 4 staff, 10 out of 10 residents and reviewed facility records. LPA also obtained copies of pertinent documents relevant to the investigation.

Allegation: Facility staff are not ensuring visitors are wearing masks.

Interviews with 7 out of 10 residents, who were able to communicate, Activity Coordinator, MedTech and 4 out of 4 staff, indicated that the facility staff are ensuring visitors to wear masks at all times. In addition, during 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: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20220721103906
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: 09/28/2022
NARRATIVE
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the visits made by LPA on 08/10/22, 09/01/22, 09/14/22, 09/17/22/, 09/28/22,to this facility, LPA observed all staff members always wore masks. Therefore, based on interviews and LPA observation this allegation is deemed Unsubstantiated at this time.

Allegation: Residents are not being showered timely

Interviews with 7 out of 10 residents, who were able to communicate, Executive Director, Activity Coordinator, MedTech and 4 out of 4 staff, indicated that all of the Oakmont of Valencia residents are scheduled to have showers at least two (2) to three (3) times a week or as needed. LPA also was informed that the facility keeps a shower log for each resident. Based on interviews and document reviews, this allegation is Unsubstantiated at this time.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5