197610184-8-30-2023-31-AS-RORN-D5ALMV-20240515085323

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610184
Report Date: 08/30/2023
Date Signed: 08/30/2023 02:04:47 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
07/24/2023 and conducted by Evaluator Mariana Agban

COMPLAINT CONTROL NUMBER: 31-AS-20230724145624

FACILITY NAME:	OAKMONT OF SANTA CLARITA		FACILITY NUMBER:	197610184
ADMINISTRATOR:	PARK, TOM		FACILITY TYPE:	740
ADDRESS:	28650 NEWHALL RANCH ROAD		TELEPHONE:	(661) 295-2025
CITY:	SANTA CLARITA	STATE: CA	ZIP CODE:	91355
CAPACITY:	121	CENSUS: 88	DATE:	08/30/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Park Tom- Executive Director		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility staff are dispensing medication not prescribed to resident.

INVESTIGATION FINDINGS:

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On 08/30/2023 Licensing Program Analyst (LPA) Mariana Agban arrived at the facility to conduct an unannounced subsequent complaint investigation. Upon arrival, LPA was greeted by the administrator, and the purpose of the visit was explained. Between 10:00- 10:38 PM, LPA interviewed two (2) more residents. LPA conducted interview with the Administrator. A review of facility files and/or document was conducted at approximetly at 11:30 AM including but not limited the resident file for Resident #1 (R-1).

Allegation 1#: Facility staff are dispensing medication not prescribed to resident.

It was alleged that the facility staff are dispensing Methadone medicication that is not prescribed for R-1. Interview with Administrator revealed that R1 is self administering their own medication. The Administrator denied the allegation. The information obtained during records reviews and interviews indicated that R-1 has done lab tests on July 24,2023 and it came back negative for methadone. (LIC 9099 Continued)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana Agban	TELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20230724145624

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: OAKMONT OF SANTA CLARITA	FACILITY NUMBER: 197610184
	VISIT DATE: 08/30/2023

NARRATIVE

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Interview with R1 revealed that the home test they have done wasn't accurate. R1 stated that they can't explain the reason for passing out during night time since they still having the same symptoms. R1 was advised to follow up with family doctor and continue on their prescribed medication. R1 stated they can't accuse facility staff since R1 is self administer their own medication and they are independent with no caregivers. Lastly, R1 stated that they haven't had any changes in their medications in years.

Based on information obtained, this allegation deemed unsubstantiated.

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

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana Agban	TELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC9099 (FAS) - (06/04)

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