306005740-5-14-2026-22-AS-APAO-DU4TSG-20260515145906

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005740
Report Date: 05/14/2026
Date Signed: 05/14/2026 03:59:12 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
07/09/2024 and conducted by Evaluator Claudia Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240709164259

FACILITY NAME:	OAKMONT OF ORANGE		FACILITY NUMBER:	306005740
ADMINISTRATOR:	ANNA PASTORES		FACILITY TYPE:	740
ADDRESS:	630 THE CITY DRIVE SOUTH		TELEPHONE:	(714) 880-8624
CITY:	ORANGE	STATE: CA	ZIP CODE:	92868
CAPACITY:	155	CENSUS: 93	DATE:	05/14/2026
		UNANNOUNCED	TIME BEGAN:	07:36 AM
MET WITH:	Dennis Robeniol		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility staff did not provide adequate supervision resulting in resident being injured.

INVESTIGATION FINDINGS:

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An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez for the purpose of delivering findings. LPA met with Executive Director (ED) Dennis Robeniol and explained the purpose of the inspection.

Complaint alleges Staff did not check on Resident 1 (R1) for approximately two hours, resulting in R1 sustaining a fall and being injured.

During the course of the investigation, LPA obtained a copy of Resident Care Notes for R1 signed by Staff 1 (S1) which indicated that on June 27, 2024, R1 had been found on the floor by their bed with lacerations by their right eye and skin tear to right wrist, 911 was called, and R1 was transported to the hospital. The Care Notes, however, do not specify if there was a lapse in time between R1’s fall and R1 being found, and do not indicate the time R1 was last checked on by staff prior to being found on the floor. R1 could not be interviewed due to their passing on July 10, 2024. (Cont. LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026

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-20240709164259

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: OAKMONT OF ORANGE	FACILITY NUMBER: 306005740
	VISIT DATE: 05/14/2026

NARRATIVE

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S1 is no longer employed at the facility and three separate attempts were made to reach S1 by phone, however, S1 could not be reached to confirm or deny the allegation. Interviews were conducted with one witness, eight facility residents, and four staff. During their interview, R1’s responsible party, Witness 1 (W1), attributed R1's fall to their medical diagnosis and stated they were unsure if R1 had sustained a laceration or skin tear as a result of the fall. W1 stated they believed there could have been a lapse of about "15 minutes" between R1’s fall and R1 being found on floor, however, stated they did not believe it was two hours. Per W1, they had no concerns regarding the care provided to R1 by the facility. During their interview, seven of eight residents denied staff not providing adequate supervision and stated that in the event they need assistance they are able to alert staff using their pendant, and staff respond within minutes. One of eight residents stated their pendant has been tested by staff and they were informed it tested operational; however, they believe it often malfunctions and therefore, they use their personal cell phone to call for assistance and staff "come right away." During their interview, four of four facility staff denied having any knowledge of R1’s fall or injury and denied having knowledge of R1 or any other resident sustaining a fall with a two hour lapse in supervision by staff.

Based on record review of R1's Care Notes and due to allegation being uncorroborated during interviews conducted, the Department is unable to determine if Facility staff did not provide adequate supervision resulting in resident being injured. Although the above 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 at this time the above allegation is unsubstantiated.

An exit interview was conducted and copy of this report was provided at the end of the inspection.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026

LIC9099 (FAS) - (06/04)

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