198602583-10-22-2021-28-AS-SCOL-CERTJX-20220525144700

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602583
Report Date: 10/22/2021
Date Signed: 10/22/2021 04:17:04 PM

Unsubstantiated

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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/19/2020 and conducted by Evaluator Linda M Almaraz

COMPLAINT CONTROL NUMBER: 28-AS-20200819152754

FACILITY NAME:	OAK PARK MANOR, LP		FACILITY NUMBER:	198602583
ADMINISTRATOR:	JOHNSON, SABRINA		FACILITY TYPE:	740
ADDRESS:	501 S COLLEGE AVENUE		TELEPHONE:	(909) 626-0117
CITY:	CLAREMONT	STATE: CA	ZIP CODE:	91711
CAPACITY:	0	CENSUS: 48	DATE:	10/22/2021
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Administrator, Donell Clark		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility did not observe changes in the resident's physical and mental health.
Resident contracted scabies while in care.
Facility did not ensure resident was drinking enough fluids.
Facility did not assist resident with eating.
Facility did not change linens regularly.

INVESTIGATION FINDINGS:

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Licensing Program Analyst's (LPA's) Jewel Baptiste and Linda Almaraz conducted a subsequent complaint visit to investigate the allegations above. LPA's was greeted by Skye Doty and explained the reason for the visit. Later at about 3:03PM, Administrator Donell Clark arrived at the facility.

The investigation consisted of the following: On 8/25/2020, LPA Almaraz interviewed former Administrator Jennifer Serrano and Staff #1-6. LPA also requested and received a staff roster, resident roster, incident reports/medical records and Resident #1-4 files. On 10/22/2021, LPA's Baptiste and Almaraz interviewed Residents #1-4, and obtain additional records.

The investigation revealed the following: In regards to allegation "Facility did not observe changes in the resident's physical and mental health." it was alleged Resident #1 had a change in behavior and changes to hethe residents heath. (Continued on an LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021

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 28-AS-20200819152754

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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: OAK PARK MANOR, LP	FACILITY NUMBER: 198602583
	VISIT DATE: 10/22/2021

NARRATIVE

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Records revealed the facility was in contact with the residents doctors and was sending the resident out for labs when requested by the doctor. Documentation showed all changes in conditions were noted and addressed. Based on interviews conducted with staff and records reviewed, the resident had agitation when the resident had to be bathed. According to the residents file, it was determined that if the resident had any type of behavior the doctor would be notified. The facility contacted all appropriate parties

In regards to allegation "Resident contracted scabies while in care" based on records reviewed and interviews conducted the facility had an issue with a rash going around at the facility a few years ago but they conducted testing on people and there was no diagnoses of scabies. Resident #1 developed a rash that would not go away. Records reviewed, revealed Resident #1 had a rash but was not diagnosed with scabies. On 1/30/2020, the resident was tested for scabies and was negative. It was also alleged that Resident #2 had scabies. Records indicated Resident #2 did not have scabies.

In regards to allegation "Facility did not ensure resident was drinking enough fluids." based on interviews conducted with staff and residents, the residents are always encourage to drink fluids. According to interviews some residents will refuse but there is a table with water available for residents at the facility. Records reviewed revealed Resident #1 was dehydrated sometime around 12/2019. Based on interviews the resident was having a hard time transitioning from the residents previous home and sometimes would deny water, sometimes food, and showers.

In regards to allegation "Facility did not assist resident with eating." Based on interviews conducted with staff and residents, the residents are fed daily and for residents that need assistance with feeding a caregiver will feed them. According to interviews with staff if residents go more than a day without eating their doctor is always contacted. Records indicated Resident #1 was given "Ensure" when the resident did not eat.

In regards to allegation "Facility did not change linens regularly." Based on interviews conducted with staff the linens are changed daily. LPA's also interviewed residents and some residents stated that their linens are changed and some stated they have to ask but are changed when requested. (Continued on an LIC9099C)

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20200819152754

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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: OAK PARK MANOR, LP	FACILITY NUMBER: 198602583
	VISIT DATE: 10/22/2021

NARRATIVE

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Based on LPA's interviews conducted, and records reviewed, investigation revealed: Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22. An exit Interview was conducted with the Administrator and a hardcopy was provided.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021

LIC9099 (FAS) - (06/04)

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