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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405809547
Report Date: 11/17/2022
Date Signed: 11/17/2022 04:52:44 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/08/2022 and conducted by Evaluator Rachael De Leon
COMPLAINT CONTROL NUMBER: 29-AS-20220908142423
FACILITY NAME:OAKS AT NIPOMO, THEFACILITY NUMBER:
405809547
ADMINISTRATOR:TRACY S. FLAHERTYFACILITY TYPE:
740
ADDRESS:177 MARY AVENUETELEPHONE:
(805) 723-5206
CITY:NIPOMOSTATE: CAZIP CODE:
93444
CAPACITY:122CENSUS: 101DATE:
11/17/2022
UNANNOUNCEDTIME BEGAN:
04:20 PM
MET WITH:Tracy Flaherty, AdministratorTIME COMPLETED:
05:05 PM
ALLEGATION(S):
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Residents not being provided adequate food service.
INVESTIGATION FINDINGS:
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Licensing program Analyst (LPA) De Leon conducted a subsequent complaint visit to the facility above to deliver final findings. LPA met with Administrator Tracy Flaherty and explained the purpose of the visit.
LPA conducted the initial complaint visit on 09/14/2022, interviewed staff, toured dining area and took pictures of the sample dinner meals served for the evening of 09/14/2022 and collected documents. LPA interviewed staff on 09/14/2022 at 4:00pm, 11/07/2022 at 4:34pm, 5:29pm, 6:29pm, 6:51pm, 7:15pm, 11/10/2022 at 2:20pm, 2:35pm, 3:10pm, 3:30pm, and 4:40pm and 11/17/2022 at 12:05pm, 12:29pm. LPA interviewed Residents on 11/02/2022 at 3:03pm, 11/04/2022 at 1:41pm, 1:47pm, 1:54pm, 4:30pm, on 11/07/2022 at 4:02pm. LPA interviewed witnesses on 11/02/2022 at 3:20pm, 4:00pm, 5:15pm , on 11/03/2022 at 5:27pm, on 11/04/2022 at 4:50pm, on 11/07/2022 at 2:44pm, 3:48pm, and 3:29pm.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De LeonTELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
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 29-AS-20220908142423
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: OAKS AT NIPOMO, THE
FACILITY NUMBER: 405809547
VISIT DATE: 11/17/2022
NARRATIVE
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On the allegation: Residents not being provided adequate food service. LPA interviewed staff, residents and witnesses which revealed 11 out of 12 staff feel being short staffed is the reason behind the food complaints. The wait times in the dining room is longer when there is not adequate staffing in the kitchen, the food gets cold if left to sit longer under heat lamps before serving, the menu is repeated often and complaints come in about meats being overcooked, hard to chew and residents are not able to cut. 4 out of 6 residents stated the staffing is short handed leading to much longer wait times, 3/6 resident believe the meat to be over cooked, too tough to cut and eat. 3/6 residents feel the food service needs improvement. 4 of 8 witnesses interviewed revealed the facility is short staffed, 4 of 8 witnesses said the food did not look appetizing. Based on the evidence this allegation is deemed Substantiated at this time.

Exit interview conducted, deficiencies cited, copy of report and appeal rights emailed to Administrator.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De LeonTELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20220908142423
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: OAKS AT NIPOMO, THE
FACILITY NUMBER: 405809547
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/17/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
11/24/2022
Section Cited
CCR
87555(b)(18)
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(b)...(18)Sufficient food service personnel shall be employed, trained and their working hours scheduled to meet the needs of residents.This requirement was not met as evidenced by:
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Administrator agreed to review regulation 87555, hire, train and a schedule kitchen staff to meet the needs of the residents in care. Send proof of reviewed regulation, new hires, schedules for the
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Based on interviews the licensee did not comply with the regulation above the facility is not employing sufficient staff to meet the food service requirement which posses a potential Health, safety and personal rights risk to residents in care.
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month, menu for the month for Food Service/Kitchen.
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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: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De LeonTELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3