<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006005
Report Date: 05/06/2022
Date Signed: 05/06/2022 03:38:04 PM

Unsubstantiated


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
12/03/2021 and conducted by Evaluator Jenifer Tirre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20211203145738
FACILITY NAME:OAKMONT OF HUNTINGTON BEACHFACILITY NUMBER:
306006005
ADMINISTRATOR:YOUNAN, HEATHERFACILITY TYPE:
740
ADDRESS:18922 DELAWARE STREETTELEPHONE:
(657) 204-4600
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92648
CAPACITY:111CENSUS: 68DATE:
05/06/2022
UNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Administrator, Sandra Acosta-LouerTIME COMPLETED:
03:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained injuries while in care.
Facility is not providing appropriate assistance for resident’s multiple falls.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jenifer Tirre made an unannounced visit to the facility for the purpose of delivering the findings for the above allegations.

On 12/03/2021, The Department received allegations of Resident sustained injuries while in care and Facility is not providing appropriate assistance for resident’s multiple falls. The investigation consisted of pertinent documents and interviews. The investigation was conducted by the Department and revealed the following:

Resident 1 (R1) moved into the facility on 11/7/2021 from residing in their home with a private caregiver while being provided 24 hour care. After being admitted to facility R1 had multiple falls within a period of 3 weeks and sustained a wrist fracture. Multiple staff interviews and R1’s care notes have revealed that on 11/20/21 R1 was found sitting on the floor of their room with discoloration on the back of their head.

CONTINUED ON LIC 809C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022
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 2
Control Number 22-AS-20211203145738
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: 306006005
VISIT DATE: 05/06/2022
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
Per Oakmont of Huntington Beach Resident Care Notes for R1, staff noted on 11/30/2021 staff called 911 Emergency services and R1 was transported to Orange Coast Memorial Medical Center and was discharged back to facility same day. On 12/1/2021 at approximately 6:30 am, Staff 1 (S1), found R1 to be sitting on the floor next to their bed and noted to be in no pain. A couple hours later at approximately 8:30 am, S1 discovered R1 sitting on their bathroom floor with pain upon movement in which staff called 911. Per investigation interviews and resident care notes R1’s family was contacted and R1 was transported to Orange Coast Memorial Medical Center. R1 was discharged back to facility same day with hard cast on left hand as indicated by Oakmont Resident care notes dated on 12/01/2021. R1 had a soft cast from a previous visit (on 11/30/2021) in which staff observed R1 become agitated and remove the soft cast. During the process, R1 lost their balance which was cause for R1’s Physician to place a hard cast on R1 as indicated in interviews with staff 1 and Staff 2.

Staff interviews reported that they began checking on R1 every 30 to 45 minutes to ensure that R1 was not on floor or attempting to leave their bed unassisted. During R1’s hospitalization at Orange Coast Memorial Medical Center dated 12/01/2021 the Emergency Room attending Physician consulted with R1’s Primary Care Physician (PCP) in recommending that R1 be admitted to a skilled nursing facility to obtain level of care needed. R1’s family declined recommendation and requested that R1 be sent back to facility. Upon return to the facility, the facility provided a 1:1 caregiver for R1 until R1’s family could find a private caregiver. Executive Director stated that Family of R1 found a private care companion to stay with R1 to keep R1 from wandering and reduce risk of falls. It was reported that facility Care staff continues to check in on R1 every 2 to 4 hours and provides services. 6 out of 6 staff interviewed confirmed that R1 was doing better with private care companion who is providing 1:1 24 hour care to R1. Since care companion has been with R1, staff have stated that no recent falls have been reported. R1’s family stated they are satisfied with the care and services the facility is providing R1.

Facility reported to family incidents, falls and provided medical treatment when necessary. In addition, Oakmont staff reported concerns to Medical professional informing Physician of R1’s status. Therefore based on interviews conducted and documents reviewed, the Department has found that the allegations to be 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 this report along with copy of LIC 811 was left at facility.

SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2