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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005740
Report Date: 12/07/2023
Date Signed: 12/07/2023 03:51:31 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
11/01/2023 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20231101104331
FACILITY NAME:OAKMONT OF ORANGEFACILITY NUMBER:
306005740
ADMINISTRATOR:ANNA PASTORESFACILITY TYPE:
740
ADDRESS:630 THE CITY DRIVE SOUTHTELEPHONE:
(714) 880-8624
CITY:ORANGESTATE: CAZIP CODE:
92868
CAPACITY:155CENSUS: 98DATE:
12/07/2023
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Anna Pastores, AdmininistratorTIME COMPLETED:
04:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not safeguard resident's personal property.

Resident sustained bruising while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the investigation of the two allegations listed above. LPA was greeted and granted entry by front desk staff after introducing himself and stating the purpose of the visit. Executive Director Anna Pastores was notified and present during the visit.

The initial complaint investigation was conducted on November 6, 2023. Records for resident R1, including the admission agreement and a waiver to inventory personal property upon admission were reviewed. LPA verified the required posting of the facility's theft and loss policy and reviewed the theft and loss log maintained by facility staff at the front desk. Documentation of staff training on theft and loss was also provided. One staff interview, one witness interview and one resident interview were also conducted during the visit.

CONTINUED ON LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
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 4
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
11/01/2023 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20231101104331

FACILITY NAME:OAKMONT OF ORANGEFACILITY NUMBER:
306005740
ADMINISTRATOR:ANNA PASTORESFACILITY TYPE:
740
ADDRESS:630 THE CITY DRIVE SOUTHTELEPHONE:
(714) 880-8624
CITY:ORANGESTATE: CAZIP CODE:
92868
CAPACITY:155CENSUS: 98DATE:
12/07/2023
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Anna Pastores, AdministratorTIME COMPLETED:
04:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not provide resident's responsible party with complete paperwork at resident's admission to the facility.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the investigation of the two allegations listed above. LPA was greeted and granted entry by front desk staff after introducing himself and stating the purpose of the visit. Executive Director Anna Pastores was notified and present during the visit.

The initial complaint investigation was conducted on November 6, 2023. Records for resident R1, including the admission agreement and a waiver to inventory personal property upon admission were reviewed. One staff interview, one witness interview and one resident interview were also conducted during the visit.

A follow-up visit was conducted on November 29, 2023. LPA was informed that the local law enforcement investigation was still ongoing and led an interview with facility administrator Anna Pastores.

CONTINUED ON LIC9099-C
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 22-AS-20231101104331
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: 12/07/2023
NARRATIVE
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5
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8
9
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32
CONTINUED FROM LIC9099

Regarding the allegation that Staff did not provide resident's responsible party with complete paperwork at resident's admission to the facility, the following has been concluded: Based on a review of R1's records maintained at the facility and provided during the initial investigation visit, the resident and their authorized representative were provided with the following elements required by Title 22 regulations: R1's Pre-admission appraisal, Identification and Emergency contact form, signed and dated Admission agreement and all its required components including the facility's theft and loss policy. The Safeguard for Cash and Valuables form is also observed to be included in the records and is observed to be blank. Both the resident and their authorized representative declined to place any specific belongings into facility safeguarding. The resident's Individual Service Plan and updated physician report are also present.

Based on the records reviewed and their corresponding dates and signatures, LPA was able to corroborate that facility staff has provided the resident and their authorized representative with all necessary items of documentation upon the resident's admission on or around August 21, 2022. As a result, the allegation is determined to be Unfounded, meaning that meaning the allegation is false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted and a copy of this report was provided to a facility representative.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 22-AS-20231101104331
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: 12/07/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
CONTINUED FROM LIC9099
A follow-up visit was conducted on November 29, 2023. LPA was informed that the local law enforcement investigation was still ongoing and led an interview with facility administrator Anna Pastores.

Additional witness interview attempted or conducted via telephone prior to the present visit.

Regarding the allegation that Staff did not safeguard resident's personal property, the following has been concluded: Based on interviews conducted, site observation and records reviewed, it was confirmed that the facility meets all Title 22 requirements for its theft and loss policy. LPA also confirmed that the missing or stolen item reported as part of the present complaint was not placed under the facility's safeguarding responsibility. Law enforcement reporting was conducted appropriately by facility staff and is still pending at the time of the present visit. Additionally, the unit where R1 is observed to be residing is equipped with a lock to be used by the resident or their authorized representative at their own discretion. The evidence available at this time could not corroborate facility staff responsibility in misplacing or stealing the item reported missing or stolen. Therefore, the allegation is found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

Regarding the allegation that Resident sustained bruising while in care, the following has been concluded: Based on interviews conducted, a skin discoloration was observed on the R1's left hand by their authorized representative and facility staff multiple days after the reported incident involving a lost or stolen item. None of the interviews conducted were able to associate the discoloration with facility staff mishandling R1 or failing to provide adequate care and supervision. As a result, the allegation is found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

An exit interview was conducted and a copy of this report was provided to a facility representative.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4