198603545-1-20-2023-28-AS-FFIS-CND35N-20230123165657

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603545
Report Date: 01/20/2023
Date Signed: 01/20/2023 05:32:05 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
01/17/2023 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20230117151541

FACILITY NAME:	OAKMONT OF COVINA HILLS		FACILITY NUMBER:	198603545
ADMINISTRATOR:	GUSTIN, PATRICIA		FACILITY TYPE:	740
ADDRESS:	1054 PARK VIEW DRIVE		TELEPHONE:	(626) 885-1800
CITY:	COVINA	STATE: CA	ZIP CODE:	91724
CAPACITY:	142	CENSUS: 42	DATE:	01/20/2023
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Patricia Gustine, administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Resident care needs are not being met due to lack of staff.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao conducted unannounced complaint investigation for the allegation listed above today. During today’s visit, LPA met Administrator, Patricia Gustin. LPA explained the purpose of today's visit regarding the above-mentioned allegation.

Investigation consisted of the following: interviews of staff from Staff #1 (S1) through Staff #4 (S4); interviews of resident from Resident#1 (R1) through Resident#5 (R5); reviewed resident#1’s record reviews, and a facility tour.

LPA obtained copies of the Staff and Resident Rosters; and resident files for Resident #1 (R1) with relevant information.

(-continued in LIC 9099 C-)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

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-20230117151541

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: OAKMONT OF COVINA HILLS	FACILITY NUMBER: 198603545
	VISIT DATE: 01/20/2023

NARRATIVE

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In regard of the allegation,“resident care needs are not being met due to lack of staff,” it was alleged that facility did not have sufficient staff to provide care to residents and residents care needs were not met.

The investigation revealed the following: Interviewed with residents from R1 to R5, all five (5) out of five (5) residents interviewed revealed that staff provided adequate care to meet residents’ activities of daily living (ADL). Four (4) out of four (4) staff, including the administrator, denied the allegation. File review revealed residents care are documented monthly or bi-weekly and staff were notified daily. There are at least three (3) caregivers at each unit on every shift.

LPA tour the facility with administrator. While LPA walked around to conduct resident interviews, LPA observed two (2) dietary staff, one (1) med tech, three (3) caregivers at memory care unit, one (1) caregiver at assisted living unit, one (1) activities coordinator, and one (1) receptionist at the facility. Therefore, facility did provide adequate care to residents and have sufficient staff to provide care to residents.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegation is UNSUBSTANTIATED.

No deficiencies are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 8.

An exit interview was conducted with Administrator. A hard copy of this report was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

LIC9099 (FAS) - (06/04)

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