306006005-8-8-2024-22-AS-MSTC-D8P77W-20240831212523

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006005
Report Date: 08/08/2024
Date Signed: 08/08/2024 12:23:12 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
07/31/2024 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240731114029

FACILITY NAME:	OAKMONT OF HUNTINGTON BEACH		FACILITY NUMBER:	306006005
ADMINISTRATOR:	ACOSTA-LOUER, SANDRA		FACILITY TYPE:	740
ADDRESS:	18922 DELAWARE STREET		TELEPHONE:	(657) 204-4600
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92648
CAPACITY:	111	CENSUS: 67	DATE:	08/08/2024
		UNANNOUNCED	TIME BEGAN:	08:37 AM
MET WITH:	Christine Greenway, Executive Director Toni Sims, Health Services Director		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility is not providing special diet meals to residents diagnosed with diabetes.
Facility is not providing adequate laundry services.
Licensee does not ensure infection control practices are maintained.
Resident records are not stored in a confidential manner.

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct the initial investigation into the six allegations listed above. LPA was greeted and granted entry by facility front desk staff after introducing himself and stating the purpose of the visit. Executive director Christine Greenway was notified of the visit and was present to assist.

During the visit, LPA accompanied by facility staff conducted a tour of the facility, including memory care unit 101, the memory care medication room and records storage, memory care laundry area, 3rd floor kitchen and dining area as well as the assisted living medication room and records storage area on the second floor. Intervention reports from pest control visits conducted by vendor Ecolab on August 1, 2024 and follow-up inspection on August 5, 2024. Documentation of the administrator certificate submission for Executive Director Greenway was also provided and reviewed.
CONTINUED ON FORM LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024

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

Control Number 22-AS-20240731114029

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 HUNTINGTON BEACH	FACILITY NUMBER: 306006005
	VISIT DATE: 08/08/2024

NARRATIVE

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CONTINUED FROM FORM LIC9099
Regarding the allegation that Facility is not providing special diet meals to residents diagnosed with diabetes, the following has been concluded: Based on interview with facility kitchen staff as well as observation of the kitchen special diet information, meal service and resident interviews, it was determined that special diet residents are placing their orders via the facility caregivers prior to the meals being prepared. Diet-appropriate substitutions are made.

Regarding the allegation that Facility is not providing adequate laundry services, the following has been concluded: During the facility visit, LPA accompanied by facility staff toured the dedicated laundry area used by memory care staff on the ground level as well as the assisted living laundry area which is located on the third floor of the physical plant. In both instances, the laundry areas observed are found to have clean, sanitary and odorless floor surfaces. Laundry equipment is also observed to be in good repair. Per a sample admission agreement reviewed and interview conducted, residents are receiving laundry services with no additional cost on a weekly basis.

Regarding the allegation that Licensee does not ensure infection control practices are maintained: At the time of the visit, one final resident was stated by facility staff to be coming off of the mandated isolation period. Isolation signs as well as appropriate PPE for staff coming in was still present on the resident's unit doorstep. Per documentation provided, facility staff has been reporting cases to public health authorities and conducting the recommended measures to limit transmission.

Regarding the allegation that Resident records are not stored in a confidential manner, the following has been concluded: Based on a complete tour of the facility's physical plant, resident records were observed to be kept in individual folders located in either the assisted living or the memory care medication rooms on the first and second level of the facility. Both locations are either accessed via staff keys or a back-up code or fob. The entry to both medication rooms was verified to be locked and inaccessible. No other records were present or observed in any other area of the facility at the time of the visit.

Based on the above evidence, the four allegations listed are found to be Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted and a copy of this report was provided to facility.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024

LIC9099 (FAS) - (06/04)

Page: 4 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
07/31/2024 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240731114029

FACILITY NAME:	OAKMONT OF HUNTINGTON BEACH		FACILITY NUMBER:	306006005
ADMINISTRATOR:	ACOSTA-LOUER, SANDRA		FACILITY TYPE:	740
ADDRESS:	18922 DELAWARE STREET		TELEPHONE:	(657) 204-4600
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92648
CAPACITY:	111	CENSUS: 67	DATE:	08/08/2024
		UNANNOUNCED	TIME BEGAN:	08:37 AM
MET WITH:	Christine Greenway, Executive Director Toni Sims, Health Services Director		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility does not have a certified administrator.

INVESTIGATION FINDINGS:

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AMENDED REPORT
On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct the initial investigation into the six allegations listed above. LPA was greeted and granted entry by facility front desk staff after introducing himself and stating the purpose of the visit. Executive director Christine Greenway was notified of the visit and was present to assist.

During the visit, LPA accompanied by facility staff conducted a tour of the facility, including memory care unit 101, the memory care medication room and records storage, memory care laundry area, 3rd floor kitchen and dining area as well as the assisted living medication room and records storage area on the second floor. Intervention reports from pest control visits conducted by vendor Ecolab on August 1, 2024 and follow-up inspection on August 5, 2024. Documentation of the administrator certificate submission for Executive Director Greenway was also provided and reviewed.
CONTINUED ON FORM LIC9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024

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-20240731114029

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 HUNTINGTON BEACH	FACILITY NUMBER: 306006005
	VISIT DATE: 08/08/2024

NARRATIVE

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CONTINUED FROM AMENDED FORM LIC9099-A
Regarding the allegation that Facility does not have a certified administrator, the following has been concluded: LPA reviewed the listing of pending applications for the renewal of RCFE Administrator certifications maintained by the Department's Administrator Certification Bureau prior to the visit and verified that the facility's Executive Director was listed on the Department's pending applications currently in review. Proof of submission of a complete application dated December 12, 2023 was provided during the facility visit. The certification was at the time valid until April 18, 2024. A new certification number valid from April 19, 2024 until April 18, 2026 was issued by the Department. It is therefore confirmed that the facility's Executive Director is in possession of a valid RCFE Administrator certificate at the time of the visit.

The allegation is therefore found to be Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. The Department has therefore dismissed the complaint.

An exit interview was conducted and a copy of this report was provided to a facility representative.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4