198320078-12-29-2021-11-AS-MVAO-CCENZZ-20220311095510

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320078
Report Date: 12/29/2021
Date Signed: 12/29/2021 08:31:34 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/10/2021 and conducted by Evaluator Don Senaha

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20211210135613

FACILITY NAME:	OAKMONT OF TORRANCE		FACILITY NUMBER:	198320078
ADMINISTRATOR:	MYLA BELSON		FACILITY TYPE:	740
ADDRESS:	3620 LOMITA BLVD		TELEPHONE:	(424) 338-4457
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90505
CAPACITY:	126	CENSUS: 88	DATE:	12/29/2021
		UNANNOUNCED	TIME BEGAN:	02:22 PM
MET WITH:	Administrator - Myla Belson		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Resident was overmedicated while in care.
Resident was undermedicated while in care.

INVESTIGATION FINDINGS:

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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. The purpose of this visit is to deliver the findings of the investigation completed.

On 12/17/2021 Licensing Program Analyst (LPA) Don Senaha and LPA Gail Johnson initiated a complaint investigation for the allegation listed above. Today’s complaint investigation was conducted with Administrator Myla Belson.

The investigation consisted of the following: LPA Senaha requested and received resident roster, staff roster and other service documents on 12/17/2021. LPA’s interviewed residents (R1-R11) and staff (S1-S5).

A plant inspection of the facility was conducted on 12/17/2021

Investigation revealed:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2021

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

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/10/2021 and conducted by Evaluator Don Senaha

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20211210135613

FACILITY NAME:	OAKMONT OF TORRANCE		FACILITY NUMBER:	198320078
ADMINISTRATOR:	MYLA BELSON		FACILITY TYPE:	740
ADDRESS:	3620 LOMITA BLVD		TELEPHONE:	(424) 338-4457
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90505
CAPACITY:	126	CENSUS: 88	DATE:	12/29/2021
		UNANNOUNCED	TIME BEGAN:	02:22 PM
MET WITH:	Administrator - Myla Belson		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

1
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9

Untrained staff administering medication(s).

INVESTIGATION FINDINGS:

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Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2021

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

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 11-AS-20211210135613

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: OAKMONT OF TORRANCE	FACILITY NUMBER: 198320078
	VISIT DATE: 12/29/2021

NARRATIVE

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Allegation: Untrained staff administering medication(s).
It is alleged that untrained staff is administering medication (s). Staff (S1-S4) stated they train on Relias training, in-service trainings and do shadowing for training purposes. Staff (S4) stated he did leave medications with the resident one time without administering the medications for resident (R1). Staff (S4) stated he understands “he shouldn’t be doing that” and staff (S4) stated staff (S3) told him not to do that. LPA reviewed Medication Administration (MAR) and MAR shows missing dosage of medications on 12/10/21.

Based on LPA’s interviews conducted and observation, 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.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 11-AS-20211210135613

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: OAKMONT OF TORRANCE	FACILITY NUMBER: 198320078
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/29/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/31/2021 Section Cited CCR 87411(d)(3)	1 2 3 4 5 6 7	87411(d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall…evidenced by safe and effective job performance. (3) Skill and knowledge...resident care and supervision… This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Licensee to conducted in-service training for staff on medication administration on 12/07/2021 and provided proof on 12/29/21. Will pass out and have them resign training document and send sign in sheet to CCLD by POC date of 12/31/21.
	8 9 10 11 12 13 14	Based on observation, record reviews and interviews, LPA confirmed staff stated staff left the medications with the resident to take on their own which poses an immediate health and safety risk to persons in care. Staff failed to sign MAR.	8 9 10 11 12 13 14
	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: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 11-AS-20211210135613

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: OAKMONT OF TORRANCE	FACILITY NUMBER: 198320078
	VISIT DATE: 12/29/2021

NARRATIVE

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Allegation: Resident was overmedicated while in care.
It is alleged that resident was overmedicated while in care. Residents (R3-R11) stated they have never seen any resident overmedicated while in care. Staff (S1-S5) stated they have never seen any resident overmedicated while in care. LPA reviewed service documents and there is no proof of an overmedicated resident while in care.

Based on LPA’s observation, 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

Allegation: Resident was undermedicated while in care.

It is alleged that resident was undermedicated while in care. Residents (R3-R11) stated they have never seen any resident undermedicated while in care. Staff (S1-S5) stated they have never seen any resident undermedicated while in care. LPA reviewed service documents and there is no proof of an undermedicated resident while in care.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2021

LIC9099 (FAS) - (06/04)

Page: 5 of 5