306006005-12-22-2022-22-AS-LADS-CMU27H-20230106160847

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006005
Report Date: 12/22/2022
Date Signed: 12/22/2022 01:56:44 PM

Substantiated

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
12/21/2022 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20221221143919

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: 72	DATE:	12/22/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Sandra Acosta-Louer		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Staff did not respond to resident's call button resulting in resident laying on the bathroom floor overnight.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA was greeted and granted entry by staff. LPA met with Executive Director Sandra Acosta-Louer and explained the reason for the visit. LPA interviewed staff and residents. The investigation into the allegation listed above revealed the following; It was reported that Resident 1 (R1) needed assistance and hit the call button in their bathroom at 8:27 pm on 12/17/2022. A review of the call button log showed calls from R1's bath at; 8:27 pm cleared 6 minutes later at 8:33 pm, 8:35 pm cleared at 8:35 pm and then on 12/18/2022 2 calls the first at 5:29 am cleared 3 minutes later and at 5:32 am and at 5:45 am cleared at 5:45 am (tested for operation by staff). Staff reported that the call button system can be cleared by pushing the top button on the pad. LPA verified this information and verified the call system is operational. R1 hit the call button for assistance twice on 12/17/2022 but inadvertently cleared both requests for help by hitting the top button on the pad. 5 out of 6 residents reported they have not been instructed on how to use the call button system. LPA reviewed R1's resident file and verified there was no documentation showing R1 had been instructed on how to use the call button system.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022

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 3

Control Number 22-AS-20221221143919

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: 12/22/2022

NARRATIVE

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Even though R1 hit the call button and cleared out their own call for assistance they had not been instructed on how to properly use the call system. Based on the evidence gathered through record reviews and interviews, the preponderance of evidence standard has been met, therefore, the allegation listed above is found to be substantiated. Violations are being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report along with citation and Appeal Rights (LIC 9058 01/16) was provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 22-AS-20221221143919

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/22/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/23/2022 Section Cited CCR 87464(f)(1)	1 2 3 4 5 6 7	Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not being met as evidenced by:	1 2 3 4 5 6 7	Licenssee states that they will instruct all residents on how to use the call system and will label the buttons on the call system so it is clear to hit the call for assistance button only once. Proof to be forwared to LPA by POC.
	8 9 10 11 12 13 14	LPA conducted a review of records and interviewed staff and residents which showed that R1 had not been instructed on how to use the call system which resulted in the staff not responding to R1's call help for 9 hours, which poses an immediatehealth health and safety risk to residents 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: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022

LIC9099 (FAS) - (06/04)

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