317000237-7-16-2020-27-AS-TORZ-BS32NC-20200731173229

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 317000237
Report Date: 07/16/2020
Date Signed: 07/16/2020 03:19:54 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/27/2020 and conducted by Evaluator Melissa Lusby

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20200327140015

FACILITY NAME:	OAKWOOD VILLAGE, INC.		FACILITY NUMBER:	317000237
ADMINISTRATOR:	ROUZBEH MORADHASEL		FACILITY TYPE:	740
ADDRESS:	3388 BELL ROAD		TELEPHONE:	(530) 889-8122
CITY:	AUBURN	STATE: CA	ZIP CODE:	95603
CAPACITY:	124	CENSUS: 57	DATE:	07/16/2020
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Rouzbeh Moradhasel		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Resident sustained multiple falls due to a lack of supervision

INVESTIGATION FINDINGS:

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LPA Melissa Lusby contacted Administrator Rouzbeh Moradhasel by phone to discuss and complete this complaint investigation and provide findings regarding the allegation listed above. The investigation was conducted by LPA Lusby and consisted of reviews of the facility records and interviews with facility administration and staff. Reporting Party was contacted and interviewed.

The complaint alleges that R1 sustained multiple falls due to a lack of supervision. Administrator, Facility nurse, and facility staff were interviewed by LPA Lusby. Based on R1's physician report, needs and service plan, signed admission agreement, facility met resident's needs. After several falls, facility acted appropriately to ensure the health and safety of R1. Facility was given a physicians report which stated Mild Cognitive Impairement and that resident could leave facility unassisted.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Melissa Lusby	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2020

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 27-AS-20200327140015

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: OAKWOOD VILLAGE, INC.	FACILITY NUMBER: 317000237
	VISIT DATE: 07/16/2020

NARRATIVE

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LPA Lusby obtain an identical physicians report with two changes: resident has Dementia and cannot leave facility unassisted. Oakwood Village was not given this physicians report while resident lived at the facility.

After conducting documentation review and staff interviews, the Department has determined that the allegation of: resident sustained multiple falls due to a lack of supervision, to be UNFOUNDED. Through document review and interviews there was no indication that the facility failed to maintain appropriately staffing levels or adequate supervision. A finding that the complaint allegation is UNFOUNDED, means that the allegation was false, could not have happened and/or is without a reasonable basis.

As a result of todays inspection, no deficiency issued. Copy of report provided to facility.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Melissa Lusby	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2020

LIC9099 (FAS) - (06/04)

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