306006005-8-30-2024-22-AS-MSTC-D8P77V-20240831212522

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006005
Report Date: 08/30/2024
Date Signed: 08/30/2024 01:37:44 PM

Substantiated

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:	08/30/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Christine Greenway, Executive Director		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff do not ensure resident's unit is free of bed bugs.

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to deliver updated findings in the investigation of the allegation 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.

A prior visit was conducted on August 8, 2024. 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 were provided.

CONTINUED ON FORM LIC9099-C

Substantiated

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: 08/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2024

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-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: 08/30/2024

NARRATIVE

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CONTINUED FROM FORM LIC9099
Regarding the allegation that Staff do not ensure resident's unit is free of bed bugs, the following has been concluded: After suspicion of the presence of a single bed bug was evidenced, facility staff conducted an inspection through its pest control vendor which corroborated the presence of bed bugs on one chair in resident's room 101. Staff interview stated the chair is usually being used by the resident's private caregiver. Resident was as a result temporarily exposed. As stated in staff interviews, a full body check was conducted finding no clear evidence of bites on the resident's person. Treatment of the unit was conducted after the inspection on August 1, 2024. The room had to be temporarily vacated by the resident and their private caregiver for the duration of the treatment as confirmed by a follow-up visit on August 5, 2024 which found no remaining evidence of bed bugs in the unit treated. LPA accompanied by facility staff conducted a tour of unit 101 and found the unit to be clean and in good repair. The presence of bed bugs in one of the facility's units is therefore confirmed even though it has since been addressed.

As a result, the allegation is found to be Substantiated, meaning that the preponderance of evidence standard has been met. A type B deficiency is cited per Title 22 Division 6 of the California Code of Regulations. The deficiency is cleared during the present visit.

An exit interview was conducted with facility staff and their regional management and a copy of this report along with appeal rights were 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: 08/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2024

LIC9099 (FAS) - (06/04)

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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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/30/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/31/2024 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	Per CCR section 87303(a) The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not met as evidenced by the confirmed presence of bed bugs in one of the facility's units which necessitated a pest control intervention.	1 2 3 4 5 6 7	Licensee is confirmed to have provided timely pest control services and treated the unit. Presence of bed bugs was confirmed to have been successfuly addressed. Deficiency cleared during the present visit.
	8 9 10 11 12 13 14	This constitutes a potential risk to the health, safety and personal rights of individuals in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2024

LIC9099 (FAS) - (06/04)

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