317000237-6-22-2022-25-AS-LMUZ-CG8NHW-20220711102926

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 317000237
Report Date: 06/22/2022
Date Signed: 06/22/2022 03:24:47 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/29/2022 and conducted by Evaluator Todd Tryon

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20220329095444

FACILITY NAME:	OAKWOOD VILLAGE, INC.		FACILITY NUMBER:	317000237
ADMINISTRATOR:	AREND VERWEIJ		FACILITY TYPE:	740
ADDRESS:	3388 BELL ROAD		TELEPHONE:	(530) 889-8122
CITY:	AUBURN	STATE: CA	ZIP CODE:	95603
CAPACITY:	124	CENSUS:	DATE:	06/22/2022
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	John O'Brien		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Resident suffered falls resulting in injury.
Staff are not documenting resident falls.
Facility falsifying medication record.
Staff turned off resident’s speaker without consent
Inadequate staffing to meet the needs of resident’s.

INVESTIGATION FINDINGS:

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On 6/22/2022 LPA Tryon arrived at the facility unanounced to continue to work on the complaint, Prior to the visit LPA had self-screened for COVID symptoms, used hand sanitizer, and wore a mask. LPA met with John O'Brien, Administrator.
LPA has interviewed residents, staff, reviewed Medication Administration Records and Incident Reports. Regarding a resident suffering an injury due to a fall, and staff not documenting falls, LPA was not able to pinpoint who this may have referred to. Given the lack of information and names, LPA is not able to conclude whether this actually happened or not. Therefore the allegations are unsubstantiated.
Regarding the facility falsifying Medication records, again, there was no specific information regarding which resident or charts might or might not have been falsified, and LPA was not able to find particular errors. Allegation is Unsubstantiated.
Regarding staff turning off a resident's speaker, since it was not known exactly what room or resident, LPA was not able to check precisely; and staff said that they did have one resident with Alexa, but they never turned if off unless the resident requested it. It is possible that staff could have unplugged a devise

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd Tryon	TELEPHONE: (916) 208-7709
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022

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 25-AS-20220329095444

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: OAKWOOD VILLAGE, INC.	FACILITY NUMBER: 317000237
	VISIT DATE: 06/22/2022

NARRATIVE

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to avoid someone listening, but LPA has no evidence to prove this. Therefore, the allegation is unsubstantiated.

Regarding inadequate staffing to meet resident needs, since LPA had no specific examples/residents to look at and got no further information from reporter, LPA was not able to say what may or may not have happened several months ago. LPA did speak with multiple residents and staff, and those interviewed by and large thought that staff are at this time able to respond to resident needs in a reasonable time period, and resident needs are largely met by staff.. Since LPA is not able to say what the situation may or may not have been at the time of the original complaint, the allegation is unsubstantiated.

No deficiencies were cited at this visit. Exit interview conducted, appeal rights provided.

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd Tryon	TELEPHONE: (916) 208-7709
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022

LIC9099 (FAS) - (06/04)

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