198320250-9-12-2024-11-AS-WGIS-D92RPH-20240912131157

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320250
Report Date: 09/12/2024
Date Signed: 09/12/2024 01:12:05 PM

Document Has Been Signed on 09/12/2024 01:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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:	198320250
ADMINISTRATOR:	MATTHEW RYAN		FACILITY TYPE:	740
ADDRESS:	3620 LOMITA BLVD		TELEPHONE:	(424) 376-3300
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90505
CAPACITY:	126	CENSUS: 87	DATE:	09/12/2024
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Judith Uy-Villaruz		TIME COMPLETED:	01:30 PM

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On 09/12/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced case management visit for an incident reported. LPA met with Executive Director, Judith Uy-Villaruz, and Health Service Director, Angelie Pasa, and the purpose of today’s visit was explained.

LPA conducted a case management due to two Special Incident Reports (SIR) regarding resident falls submitted to Community Care Licensing (CCL) on 08/30/24. Resident R1 experienced a fall on 08/25/24 resulting in an injury requiring stitches. Resident R2 experienced a fall on 08/26/24 resulting in a fracture requiring surgery.

During today’s visit, LPA toured the facility, checked all hallways, walkways, common rooms, and resident R1 and R2 rooms. LPA observed all walkways and hallways to be clean, clear, and free of obstructions and hazards. All common rooms and Resident R1 and R2’s room was observed clean, clear, and free of hazards.

LPA reviewed resident R1’s Physician’s Report, Needs and Service Plan (updated 06/30/24), Care Assessment, Fall Risk Assessment, hospital discharge paperwork, Internal Incident Report, and Progress Notes. LPA observed R1 has no history

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

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

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 198320250
	VISIT DATE: 09/12/2024

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of falls and there have been no indications of being a fall risk. LPA reviewed resident R2’s Physician’s Report, Resident Care Assessment (updated on 06/07/24), Fall Risk Assessment, and Internal Incident Report. LPA observed R2 is completely independent and does not require any assistance. R2 has not experienced any falls in the past.

LPA did not observe or cite any deficiencies.

An exit interview was conducted with Executive Director, Judith Uy-Villaruz, Health Service Director, Angelie Pasa, and a copy of this report was provided.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

LIC809 (FAS) - (06/04)

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