405809547-7-2-2025-29-AS-KBUY-DK4PCK-20250731111205

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405809547
Report Date: 07/02/2025
Date Signed: 07/02/2025 05:07:55 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
06/19/2025 and conducted by Evaluator Melisa Rankin

COMPLAINT CONTROL NUMBER: 29-AS-20250619151313

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: 95	DATE:	07/02/2025
		UNANNOUNCED	TIME BEGAN:	11:16 AM
MET WITH:	Ronald Freeman, Raquel Cousins		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Licensee does not ensure that resident's are provided with an adequate supply of hygiene items while in care.

Licensee does not ensure that resident is provided appropriate activities while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rankin conducted a subsequent complaint visit to the facility above to issue final findings. LPA met with Ronald Freeman, Administrator and explained the purpose of the visit. During the initial visit on 6/23/25 from 10:55 am to 3:00 pm, LPA Rankin toured the memory care unit at the facility, interviewed two (2) staff, one (1) resident from Memory Care, and two (2) residents from Assisted Living, observed Memory Care residents and the activities, and obtained relevant documents. Additional interviews were conducted with relevant parties on 6/20/25, and 7/1/25.

During return visit LPA re-toured the memory care unit and specifically 21 resident restrooms and two (2) staff/resident restrooms. LPA interviewed three (3) staff and one (1) director.
(pg1) Continued 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025

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-20250619151313

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: OAKS AT NIPOMO, THE	FACILITY NUMBER: 405809547
	VISIT DATE: 07/02/2025

NARRATIVE

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On the allegations: Licensee does not ensure that residents are provided with an adequate supply of hygiene items while in care. It was alleged that on multiple visits a witness observed residents in the memory care unit without toilet paper in their restrooms and in some instances with the toilet paper holder removed. During an initial visit on 6/23/25, LPA toured 18 out of 21 restrooms and found that each room except one (1) had toilet paper, all rooms had a toilet paper holder. LPA also toured the 2 restrooms that are used by staff and if needed residents, and all restrooms had toilet paper. LPA interviewed two staff who stated they provide toilet paper to residents, but there are times when a resident who is able to use the restroom unassisted uses their toilet paper and staff do not know until they check on the resident. Prior Staff member via a phone conversation stated that caregivers are to check the toilet paper at minimum when emptying the trash which is done on each shift.

The interview with maintenance staff stated they have extra toilet holders on hand due to residents, especially in the memory care unit, mistaking the toilet role holder as a grab bar and pulling the holder off the wall. Staff stated they have never been asked to remove a holder but does know there are times the brackets remain after the holder has been pulled off the wall. Maintenance staff was asked are you having any plumbing issues on the memory care side, staff stated no. At this time all staff interviewed stated they do not have residents with behaviors that are causing them to clog the toilets so no toilet paper is being withheld for that reason.

On return visit of 7/2/25, LPA again toured 21 out of 21 resident restrooms in the memory care unit and the two (2) staff/public restrooms and found that all restrooms besides one (1) had toilet paper on the toilet roll holder, the one (1) room with it not on the holder, the toilet paper, and the toilet roll insert were on the counter, accessible to the resident if need. LPA also looked under approximately 10 sinks where staff stated extra toilet paper from family is stored. Some residents did not have additional supplies; staff were able to explain that there are four (4) residents having behaviors with toilet paper on occasion and therefore some families ask the director to keep the supply in the medication room. A pack of toilet paper was observed by the LPA in the medication room.
(pg2) Continued on 9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 29-AS-20250619151313

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: OAKS AT NIPOMO, THE	FACILITY NUMBER: 405809547
	VISIT DATE: 07/02/2025

NARRATIVE

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All staff interviewed stated that about 85% of residents in memory care are incontinent and wear adult briefs. The process to assist these residents is to assist in toileting and / or changing briefs every 1 – 2 hours.

Based on the information obtained, interviews conducted, and observations during the touring of the facility conducted on two occasions from licensing, there is not a preponderance of evidence to prove the alleged violation occurred, therefore the allegation is Unsubstantiated at this time.

On the allegation: Licensee does not ensure that resident is provided appropriate activities while in care. It was alleged that Resident 1 (R1) has asked to participate in activities on the assisted living side, but staff refuse to let R1 go. The reporting party stated that the activities in the memory care unit do not interest R1. During interviews with staff and residents, it was affirmed that R1 was able to attend events on the assisted living side at one time but has not been able to attend due to the supervision required while R1 is outside of memory care unit. Director and Administrator stated the resident could participate in assisted living events if family participated with R1 or provided someone to attend with R1. LPA reviewed R1’s record and noted that R1 is not currently paying for additional services regarding the following charge noted in the “Residency Agreement” which states an additional fee would be charged for escort to activities is needed:

“In addition to the services listed in this Agreement and the services provided under “Residential Services” (Section I.A), residents may receive one or more of the following services, as needed, for an additional fee:
(a) Assistance with…Escort to recreational, social, or religious activities provided on-site."

Interview with two (2) residents from the assisted living area stated that the friends R1 would participate with have since moved, or passed, additionally R1 would attend meetings and would become disruptive, they also stated R1 would get lost in the elevator and was unsure how to get back down. The residents also stated that the events they had while R1 lived in assisted living, R1 never participated in. R1 enjoyed conversations with specific friends and believes that R1 may still be seeking those friends. The residents interviewed did state that they are willing to meet with or set up calls to visit R1 and ask if there are any items R1 would like discussed in the meetings for complaints and improvements.

(pg3) continued on 9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20250619151313

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: OAKS AT NIPOMO, THE	FACILITY NUMBER: 405809547
	VISIT DATE: 07/02/2025

NARRATIVE

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Interview with the memory care Director, was stated that they have had events where they specifically ask R1 what they would like to do this particular day, they call it “[R1] picks”, they also asked for someone from the history museum that comes to the assisted living side, to also come to the memory care side which is something and someone that R1 likes to converse with. Director also stated R1 will appear interested one day and when the activity is scheduled, R1 chooses not to participate. They have also incorporated scenic drives in which R1 has participated in. Facility is hoping that provides a chance for R1 to socialize. LPA did note that event is on the activities calendar.

LPA interviewed R1 in their room and observed R1 speak with the director about 30 minutes later. R1 was able to state they want to have social conversations, R1 was able during the visit, to carry on a back-and-forth conversation, was pleasant and sociable. R1 did however not remember specifics, could not provide LPA with what activities R1 wanted to participate in, and when R1 was observed in conversation in directors’ office, while pleasant, did not remember the LPA.

Based on the information obtained, interviews conducted, and observations of licensing, there is not a preponderance of evidence to prove the alleged violation occurred, therefore the allegation is Unsubstantiated at this time.

Exit interview done, report given.

(pg4)

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025

LIC9099 (FAS) - (06/04)

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