<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320078
Report Date: 11/17/2023
Date Signed: 11/17/2023 11:29:35 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/07/2021 and conducted by Evaluator Mario Leon
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20211207104245
FACILITY NAME:OAKMONT OF TORRANCEFACILITY NUMBER:
198320078
ADMINISTRATOR:FERNANDEZ, TAMARAFACILITY TYPE:
740
ADDRESS:3620 LOMITA BLVDTELEPHONE:
(424) 338-4457
CITY:TORRANCESTATE: CAZIP CODE:
90505
CAPACITY:0CENSUS: 90DATE:
11/17/2023
UNANNOUNCEDTIME BEGAN:
08:24 AM
MET WITH:Angelie Pasa, Health Services DirectorTIME COMPLETED:
10:10 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility did not notify responsible party of abuse
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/17/23 Licensing Program Analyst (LPA) Mario Leon conducted a subsequent, unannounced, complaint visit to this facility and met with Angelie Pasa, Health Services Director. The purpose of this visit was to deliver findings.

The investigation consisted of the following:
On 12/08/2021 Licensing Program Analyst (LPA) Don Senaha initiated a complaint investigation for the allegation listed above. LPA requested and received resident roster, staff roster and other service documents on 12/08/2021. LPA interviewed staff (S1-S5) and conducted a plant inspection of the facility.
On 12/29/2021 Licensing Program Analyst (LPA) Don Senaha conducted a subsequent unannounced complaint visit to this facility and met with Administrator Myla Belson. LPA interviewed residents (R1-R9) and staff (S6).

Report continues, see LIC9099C.
Substantiated
Estimated Days of Completion: 90
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Mario LeonTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
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 11-AS-20211207104245
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: OAKMONT OF TORRANCE
FACILITY NUMBER: 198320078
VISIT DATE: 11/17/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
On 02/02/2022 LPA Don Senaha conducted a plant inspection of the facility.

The investigation revealed the following:
Regarding the allegation: “Facility did not notify responsible party of abuse.” Facility records indicate that the suspected abuse for resident (R1) took place on 10.15.21. Administrator reported the incident on 12.6.21 to CCLD of suspected abuse which is a Title 22 violation of reporting requirements. Community Care Licensing Division (CCLD) records indicate that no reporting of suspected case of abuse of resident (R1) was made prior to 12.06.22 from the facility to Licensing. Interview with staff revealed that: Staff did not report this incident to Administrator until 11.30.21.

Based on LPA’s interviews conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.

An exit interview was conducted with Angelie Pasa, Health Services Director, and appeals rights and a copy of this report was provided.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Mario LeonTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20211207104245
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: OAKMONT OF TORRANCE
FACILITY NUMBER: 198320078
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/24/2023
Section Cited
CCR
87211(a)(1)(D)
1
2
3
4
5
6
7
87211 Reporting Requirements (a) Each licensee shall furnish… (1)A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence…(D)Any incident which threatens the welfare, safety or health of any resident…
1
2
3
4
5
6
7
The Licensee agreed to complete an in-service training on reporting requirements and mandated reporting by 11/24/23. Administrator will submit the section(s) covered during the training, length of time of training and sign-in sheet of staff who were present including printed names and
8
9
10
11
12
13
14
This requirement is not met as evidenced by:
Based on record reviews and interviews, licensee did not report a suspected abuse in a timely manner which poses a potential health and safety risk to persons in care.
8
9
10
11
12
13
14
their signatures. Licensee will submit in-service training, via email, at Mario.Leon@dss.ca.gov
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Mario LeonTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/07/2021 and conducted by Evaluator Mario Leon
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20211207104245

FACILITY NAME:OAKMONT OF TORRANCEFACILITY NUMBER:
198320078
ADMINISTRATOR:FERNANDEZ, TAMARAFACILITY TYPE:
740
ADDRESS:3620 LOMITA BLVDTELEPHONE:
(424) 338-4457
CITY:TORRANCESTATE: CAZIP CODE:
90505
CAPACITY:0CENSUS: DATE:
11/17/2023
UNANNOUNCEDTIME BEGAN:
08:24 AM
MET WITH:Angelie Pasa, Health Services DirectorTIME COMPLETED:
10:10 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff physically abused resident in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/17/23 Licensing Program Analyst (LPA) Mario Leon conducted a subsequent unannounced complaint visit to this facility and met with Angelie Pasa, Health Services Director. The purpose of this visit was to deliver findings.

The investigation consisted of the following:
On 12/08/2021 Licensing Program Analyst (LPA) Don Senaha initiated a complaint investigation for the allegation listed above. LPA requested and received resident roster, staff roster and other service documents on 12/08/2021. LPA interviewed staff (S1-S5) and conducted a plant inspection of the facility.
On 12/29/2021 Licensing Program Analyst (LPA) Don Senaha conducted a subsequent unannounced complaint visit to this facility and met with Administrator Myla Belson. LPA interviewed residents (R1-R9) and staff (S6).

Report continues, see LIC9099C
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Mario LeonTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
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 11-AS-20211207104245
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: OAKMONT OF TORRANCE
FACILITY NUMBER: 198320078
VISIT DATE: 11/17/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
On 02/29/24 Licensing Program Manager (LPM) Ulysses Coronel and Licensing Program Analyst (LPA) Mario Leon arrived to deliver an amended document. This is an amended document provided to include additional information to be recorded on file. This is an amendment of the complaint investigation report delivered on 11/17/23. LPM and LPA were met by Judith Uy-Villaruz, Executive Director, and there have been no changes to the initial findings.

On 02/02/2022 LPA Senaha conducted a plant inspection of the facility.

The investigation revealed the following:

regarding the allegation: “Staff physically abused resident in care.” Record reviews indicate the facility conducted an internal investigation regarding the alleged incident, the findings were inconclusive. Although redness was observed on resident’s neck, it was not clear how this redness occurred. Interviews indicate the following: Witness (W1) stated they have no physical evidence of alleged abuse. Resident (R2-R7, R9) stated they have never been hurt on purpose by anyone at the facility. Resident (R2-R7, R9) stated they have never been physically abused by staff. Resident (R2-R7, R9) stated they have never seen staff been abusive towards other residents. Staff (S1-S7) stated they have never been upset or have any issues with residents. Staff (S1-S7) stated they have never seen any staff be physically or verbally abusive to residents. Staff (S1-S7) stated if there are any issues, they report to the med-tech or nurse immediately.

Based on LPA’s interviews conducted and records reviews, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated.

An exit interview was conducted with Angelie Pasa, Health Services Director, and a copy of this report was provided.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Mario LeonTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5