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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603479
Report Date: 08/28/2025
Date Signed: 08/28/2025 05:20:04 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
11/13/2024 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20241113164508
FACILITY NAME:OAKMONT OF WHITTIERFACILITY NUMBER:
198603479
ADMINISTRATOR:RUNGE, ADRIANEFACILITY TYPE:
740
ADDRESS:13617 WHITTIER BLVD.TELEPHONE:
(562) 693-8222
CITY:WHITTIERSTATE: CAZIP CODE:
90605
CAPACITY:97CENSUS: 68DATE:
08/28/2025
UNANNOUNCEDTIME BEGAN:
04:53 PM
MET WITH:Adriane Runge - Executive DirectorTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Facility staff caused injuries to resident during a transfer.
INVESTIGATION FINDINGS:
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**This Report Supersedes report dated 12/18/24 as the wrong regulation was cited during visit, citation was issued for regulation, 80072(a)(2) Personal Rights and is being corrected to 87468.1(a)(2) Personal Rights no additional changes have been made to the report and findings remain the same**

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced subsequent compliant visit LPA met with Adriane Runge and explained the purpose for todays visit.
The investigation consisted of the following:
During initial visit dated 11/14/24 LPA obtained copies of Staff and Resident Roster, and obtained copies of medical documents and current incident report from Resident #1's file, due to time constraints the allegation needed further investigation. On 12/28/24 LPA obtained copies of Staff and Resident Roster, interviewed 6 Staff (S1-S6) and 10 Residents (R1-R10), Reviewed Training and Participants for proper use of Hoyer Lift, toured R1-R4's rooms and S4 demonstrated each Hoyer Lift.
(continued on LIC9099-C)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
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 3
Control Number 28-AS-20241113164508
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: OAKMONT OF WHITTIER
FACILITY NUMBER: 198603479
VISIT DATE: 08/28/2025
NARRATIVE
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The Investigation Revealed the Following:
Allegation: Facility staff caused injuries to resident during a transfer.
It is alleged that R1 sustained injuries to their head during a transfer using a Hoyer Lift, that was assisted by S2 and S3. LPA conducted interviews with staff and 3 out of 6 staff confirmed the above allegation. S2 and S3 both confirmed the above allegation and stated that when they were using the hoyer lift, it was giving them trouble, the wheels got stuck and R1 landed on their bed from the hoyer lift. Part of the hoyer lift, grazed R1's forehead and R1 landed on her pillow, moments later blood was observed on the pillow and it was seen that R1 had an injury to the back of their head, 911 was called immediately. LPA reviewed in-service training for staff on usage of hoyer lift and it was explained to LPA by S1 that there is no documentation or proof that training prior to this incident was held. Since incident there have been 2 in-service training's dated 11/27/2024 and 12/4/2024, during staff interviews it was revealed that S6 has not received training for the hoyer lift and use the hoyer lift to assist residents with transfers. LPA interviewed residents and 8 out of 10 residents denied the allegation and stated they have never sustained injuries while being assisted nor have the witnessed/heard of any other resident sustaining an injury while being provided assistance/transfer. 2 of the 10 residents interviewed have a cognitive impairment that did not allow for successful interview.

Based on observations and interviews which were conducted and record review, 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 1 are being cited on the attached LIC 9099D.

Immediate Civil Penalties were issued on 12/28/24, in the amount of $500.00 due to Staff caused serious injury to resident.

At this time an Enhanced Civil Penalty (ECP) determination is pending in reference to Health and Safety Code 1569.49(f) and may be assessed at a later date.

Exit interview held and a copy of this report, appeal rights and civil penalty assessment were provided to Adriane Runge - Executive Director.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20241113164508
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: OAKMONT OF WHITTIER
FACILITY NUMBER: 198603479
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
08/28/2025
Section Cited
CCR
87468.1(a)(2)
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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
This requirement was not met as evidence by:
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This POC was already previously corrected as LPA receievd a copy of the in-service training information for staff that need training in Hoyer Lift, training is scheduled for 12/20/24 and 1/17/25 LPA receieved signatures of staff that have completed the training.
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Resident #1 (R1) sustained injuries to their head on 11/11/2024 during staff assistance with a transfer using a hoyer lift. R1 head laceration (J staples), and a large scalp hematoma as a result.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3