405809547-2-27-2025-29-AS-KBUY-DEBTAM-20250228133346

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405809547
Report Date: 02/27/2025
Date Signed: 02/27/2025 02:08:18 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
01/30/2025 and conducted by Evaluator Rachael De Leon

COMPLAINT CONTROL NUMBER: 29-AS-20250130150442

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: CA	ZIP CODE:	93444
CAPACITY:	122	CENSUS:	DATE:	02/27/2025
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Ronald Freeman, Administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff did not provide a proper eviction notice to resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) De Leon conducted a subsequent complaint visit to the facility above. LPA met with Administrator Ronald Freeman and explained the purpose of the visit.

LPA De Leon conducted the initial 10-day complaint visit, toured facility, requested records and interviewed staff at 10:45am, 11:00am, 12:40pm, 1:10pm, 1:20pm, 2:52pm and 3:11pm and interviewed residents at 11:20am, 11:45am, 2:00p and 2:20pm. LPA conducted a subsequent visit and interviewed staff and residents from 10:45am-1:30 pm.

On then allegation: Staff did not provide a proper eviction to resident in care. LPA reviewed records regarding Resident 1’s (R1’s) eviction letter, Admission Agreement with Resident Handbook, and House Rules, and Letters to R1 from the facility, as well as interviewed staff and residents.
Continued 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025

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 29-AS-20250130150442

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: 02/27/2025

NARRATIVE

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LPA De Leon reviewed R1’s Eviction Letter dated 01/27/2025, Admission Agreement with Resident Handbook with House Rules. The eviction letter includes Article II. E.2.a.(3) of the Agreement which states that the Community may, upon thirty (30) days written notice, evict a resident if (3) resident fail to comply with the general policies of the Community, this is also in the Admission Agreement page 12, this agreement was dated and signed by R1 on 09/08/2022. The policies are described in the Admission Agreement on page 19 under I. Miscellaneous 1. Rules and Regulations c. which states, Residents must not be disruptive, engage in conduct that poses a danger to themselves or others at the community, create unsafe conditions, or be physically or verbally abusive to other residents or staff. On Pages 31-35 Appendix D of the Resident Handbook House Rules page 34 states: Respect for Others: Residents, their guests and family members, must display respect for others in the community. Neither verbal or nor physically abusive behavior towards residents, employees, visitors, and/or anyone who is present in the Community will be tolerated.

In Appendix E on page 36 The Oaks at Nipomo statement of Residents Personal Rights pursuant to title 22, California Code of Regulations, Section 87468.1(a) Residents in all residential care facilities for the elderly shall have all the following personal rights (1) To be accorded dignity in their personal relationships with staff, residents and other person and well as (2) To be accorded safe, healthful and comfortable accommodations, furnishings, and equipment. The interviews conducted during the course of the investigation of R1’s Eviction, R1 is infringing on other resident’s personal rights and causing a hostile environment for staff as well as other residents.

LPA reviewed letters to R1 dated 11/15/2024, 11/28/2024, and 12/11/2014 all letters were regarding R1’s harassing staff or other residents and reminders about R1’s needs to follow house rules. R1 has been counselled on several occasions from 2023-2025 regarding harassment to staff and residents and on 01/27/2025 an eviction was issued.
According to 7 out of 10 staff interviewed revealed R1 to be very rude to staff and other residents, tries to get into other residents’ business, harasses and makes some staff feel uncomfortable.
According to 9 out of 9 residents interviewed R1 has been rude, harassing, yelled and belittled other residents in dining and activities. Several residents will no longer join R1’s table for meals or partake in activities that R1 has joined.
Based on the evidence this allegation is Unsubstantiated, the eviction is lawful, at this time.

Exit interview conducted and copy of report printed for Administrator.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025

LIC9099 (FAS) - (06/04)

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