405809547-9-15-2023-29-AS-KBUY-CW325D-20230926170521

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405809547
Report Date: 09/15/2023
Date Signed: 09/15/2023 12:33:12 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, 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
08/16/2023 and conducted by Evaluator Rachael De Leon

COMPLAINT CONTROL NUMBER: 29-AS-20230816143650

FACILITY NAME:	OAKS AT NIPOMO, THE		FACILITY NUMBER:	405809547
ADMINISTRATOR:	RONALD C. FREEMAN		FACILITY TYPE:	740
ADDRESS:	177 MARY AVENUE		TELEPHONE:	(805) 723-5206
CITY:	NIPOMO	STATE:	ZIP CODE:	93444
CAPACITY:	122	CENSUS: 98	DATE:	09/15/2023
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Ron Freeman, Administator		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Facility does not provide adequate amounts of toilet paper to residents in care.

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 of the complaint investigation. LPA met with the Administrator Ron Freeman and explained the purpose of the visit.

LPA De Leon conducted the initial complaint visit on 08/23/2023, LPA requested staff roster with telephone numbers, resident roster, invoices for billing of toilet paper for 2022-2023, staff schedule for August 2023 all departments. The administrator provided all the above except the invoices for toilet paper as none of the residents have been billed for toilet paper. The facility does provide housekeeping 1 day a week in each resident’s room and the housekeepers are instructed to put toilet paper if the resident’s bathroom if it does not have any. The Admission Agreement was reviewed, and it does not state the facility provides toilet paper free of charge and it does not state toilet paper is an extra charge. LPA interviewed staff on 08/23/2023 around 10:15am, 11:10am, 11:50am, 12:05pm, 1:05pm, 1:20pm, 1:40pm, 2:20pm, 3:30pm, 4:15pm, and residents around 12:15pm, 12:30pm, 12:45pm, and 2:55pm. Continued 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2023

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-20230816143650

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: 09/15/2023

NARRATIVE

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LPA De Leon made a subsequent complaint visit on 08/24/2023, LPA requested Resident welcome packet, copy of the new care fee increase letter, time clock/payroll records for care staff, kitchen staff, and housekeeping staff working on 08/20/2023, 08/22/2023, and 08/24/2023 for each shift AM/PM/NOC, Pendent press records for 06/2023-08/2023 for 2 residents, Staff disciplinary records for 2023. The administrator needed additional time to get some of the records and will provide them to LPA by Monday. LPA interviewed additional staff on 08/24/2023 around 11:18am and residents around 12:20pm, 12:40pm, 1:45pm, 2:12pm, 3:15pm and 5:00pm.

On the allegation: Facility does not provide adequate amounts of toilet paper to residents in care. LPA conducted interviews with 11 staff and 11 residents which revealed all 22 stating the residents purchased their own grooming, hygiene, and toiletries items to include toilet paper. Resident 1 (R1)-Resident 11(R11) stated they did not know the facility provided toilet paper to residents free of charge. Two residents stated they have a preference in brand and would still purchase their own toilet paper even if the facility provided it.

Staff interviewed stated residents can chose to use the toilet paper the facility provides, or residents can continue to purchase what they prefer. Multiple staff interviewed stated residents or their families bring their own personal grooming and toiletries. Some staff indicated they did not know that the facility provided it to the residents, and thought the residents and families just provided it. Multiple staff said the residents bring their own toilet paper and thinks it is because the residents do not like the brand the Facility uses. Staff stated that housekeeping (HK) staff cleans rooms 1 time per week, and HK staff are instructed to put toilet paper in the bathroom if the roll is empty or low. Multiple staff interviewed when residents have run out of toilet paper, they let housekeepers or maintenance know, and they provided the residents with toilet paper until the residents or families brought it in. Multiple staff stated the facility did not charge for it. One staff recalled a time where one resident did not have any toilet paper and the staff did provide several rolls at no charge, but could not provide an exact date. One staff stated they have provided toilet paper to residents and did not make residents pay it back or pay for it, and has never turned in a resident room or name to anyone to bill for it. Staff said the facility would provide toilet paper when the residents were out and that was never a problem to do. Staff stated the facility gets donations from families when residents move out or pass away so the staff have a drawer with extra supplies that can be used when someone runs out of something. One staff remembers a resident being out of toilet paper and staff provided it from the donation supply and called the family to let them know the resident needed toilet paper, the staff did not charge for it when provided by the facility. Continued 9099-C

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20230816143650

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: 09/15/2023

NARRATIVE

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LPA reviewed the admission agreement, and it does not state the facility provides toilet paper under basic services and it does not state that toilet paper is an extra charge under additional services. The welcome packet for new residents was reviewed and there was nothing in the packet that indicated the residents were to provide toilet paper. LPA asked for copies of invoices for 2022-2023 for residents billed for toilet paper, the facility could not provide any records as no residents had been billed for toilet paper during 2022-2023. There is no evidence to support the facility does not provide adequate amounts of toilet paper to residents in care therefore the allegation is deemed Unsubstantiated at this time.

Exit interview and copy of report printed for Administrator.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2023

LIC9099 (FAS) - (06/04)

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