306005673-7-23-2021-22-AS-AORZ-C7LPEK-20211008111516

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005673
Report Date: 07/23/2021
Date Signed: 07/23/2021 12:57:29 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/08/2021 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210108122556

FACILITY NAME:	OAKMONT OF HUNTINGTON BEACH		FACILITY NUMBER:	306005673
ADMINISTRATOR:	AYALA, ROSA		FACILITY TYPE:	740
ADDRESS:	18922 DELAWARE STREET		TELEPHONE:	(657) 204-4600
CITY:	HUNTINGTON	STATE: CA	ZIP CODE:	92648
CAPACITY:	111	CENSUS: 76	DATE:	07/23/2021
		UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Administrator, Heather Younan		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff neglect resulting in death of resident.
Resident suffered from dehydration resulting in resident being hospitalized.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jenifer Tirre visited the facility for the purpose of delivering the findings for the above allegations. The investigation consisted of interviews conducted with Care 1 LLC personnel, Primary Physician, and Oakmont of Huntington Beach Staff. The investigation revealed the following:

On 01/08/21 The Department received allegations of staff neglect resulting in death of resident and Resident suffered from dehydration resulting in resident being hospitalized. The investigation was conducted by the Department. The investigation revealed the following: Resident 1 (R1) moved into the facility on 09/03/2020 and as part of the on boarding procedure was placed in a temporary room where they were isolated and provided 24/7 care by a facility contracted private caregiver for a period of 7 days. It was revealed that R1 had continuous care while at facility. Six out of six staff interviewed confirmed that R1 had a private caregiver assigned to them and were providing watch 24/7 while under isolation. After a period of isolation, R1 was transferred to the facility memory care unit.
CONTINUED ON LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021

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 22-AS-20210108122556

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: OAKMONT OF HUNTINGTON BEACH	FACILITY NUMBER: 306005673
	VISIT DATE: 07/23/2021

NARRATIVE

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Interviews also confirmed that facility staff and private caregivers were providing meals, liquid refreshments, assistance with activities of daily living (ADL’s) and clean linens for R1 while in care. All facility staff and private caregivers interviewed stated that R1 had a good appetite, drank fluids when provided and attended the facility activity center. Medical records obtained revealed that R1 suffered from Non-Hodgkin’s Lymphoma and had already undergone chemotherapy once and was scheduled to complete a second round of treatment later.

R1 passed away on September 19, 2020. In an interview with R1’s Oncologist Physician, Oncologist stated R1 had a history of Lymphoma and within two weeks had a steady decline in health which resulted in R1 having weakness, confusion and the inability to walk or eat. Although lab results confirmed R1 was dehydrated, Oncologist stated they don’t believe the dehydration contributed to the quickening result of R1’s death. A copy of R1’s death certificate noted the cause of death as cardiac arrest and Non-Hodgkin’s Lymphoma. No evidence of neglect was noted during this investigation.

Therefore, based on interviews conducted and documents reviewed, the Department has found that the complaint was UNSUBSTANTIATED meaning although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted with Administrator and a copy of report was provided to facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021

LIC9099 (FAS) - (06/04)

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