306006005-3-7-2023-22-AS-LADS-CPYSEX-20230316134927

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006005
Report Date: 03/03/2023
Date Signed: 03/07/2023 03:41:23 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 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
01/06/2023 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230106141708

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:	03/03/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Administrator, Sandra Acosta-Louer		TIME COMPLETED:	02:50 PM

ALLEGATION(S):

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Facility has insufficient staffing to meet the resident's needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jenifer Tirre made an unannounced visit to deliver findings on the complaint investigation. LPA met with and discussed the purpose of the visit with Administrator, Sandra Acosta-Louer.

The department investigated the above allegation and the investigation consisted of interviews, observations, and documentation. It was alleged that Facility has insufficient staffing to meet the resident’s needs. Investigation revealed that on January 2, 2023 an incident occurred where Resident 1 (R1) had a fall in facility which staff stated resident showed no signs of injury, awhile later resident began to vomit and became unresponsive prompting Facility staff to call 911 in which resident was then transported to hospital. At time of incident two med technicians and Health Services Director were present. Facility documents show morning of incident that facility had two med tech’s, Five caregivers, Five directors and one house keeper were present in building Facility Personnel Report reveals that on day of incident Memory Care had three caregivers, one med tech and two directors assisting residents during AM shifts as well as three caregivers and one med tech for PM shift. CONTINED ON 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023

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-20230106141708

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: OAKMONT OF HUNTINGTON BEACH	FACILITY NUMBER: 306006005
	VISIT DATE: 03/03/2023

NARRATIVE

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Facility Roster shows there are 24 caregivers that work in Memory care unit and 16 caregivers in Assisted Living. Facility Task sheets indicate that resident 1 had daily status checks every two hours. According to staff interviews Caregivers that are scheduled to Assisted Living also help out in Memory Care wing. Staff interviews revealed that Facility hasn’t had a need for outside staffing agencies since July 2022. Resident interviews revealed that three out of four Residents feel there is always staff available to assist them in Memory care unit. Residents interviewed were all aware they were residing in a Residential Care Facility.

During visit on 1/12/23, LPA observed Five Care staff assisting in Memory care unit as well as Executive Director and Health Services Director.

Based on conflicting information provided from interviews LPA is unable to determine if the alleged violation occurred as reported.

We have found the complaint allegation is UNSUBSTANTIATED, although the allegation may have happened or is valid; there is not a preponderance of evidence to prove that the alleged violation occurred as reported.

This report is being reviewed with administrator and a copy of this report along with a LIC 811 confidential names list was left at the facility.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023

LIC9099 (FAS) - (06/04)

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