405809547-8-23-2024-29-AS-KBUY-D8MLX9-20240830090823

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405809547
Report Date: 08/23/2024
Date Signed: 08/23/2024 10:48:23 AM

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
08/13/2024 and conducted by Evaluator Melisa Rankin

COMPLAINT CONTROL NUMBER: 29-AS-20240813082147

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:	08/23/2024
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:			TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Facility refused to provide transportation for the resident's appointment.

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 and explained the purpose of the visit.

During the investigation, LPA Rankin conducted an initial visit on 8/19/24 from 10:58am to 2:15pm, toured the common areas of the facility, interviewed staff, interviewed residents, and obtained documents. LPA conducted additional interview with resident 1 (R1) on 8/23/2023 at 9:05 am.

Continued to 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Melisa Rankin	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024

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 4

Control Number 29-AS-20240813082147

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: 08/23/2024

NARRATIVE

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On the allegation: Facility refused to provide transportation for the resident's appointment. It was alleged that staff refused to provide transportation back from a scheduled medical appointment. R1 stated the appointment was last minute due to an infection, doctor was able to accommodate an urgent appointment. R1 stated the facility agreed to take them, but R1 would need to pay for transportation through another source to get home. R1 did not want to pay for alternative transportation and felt the facility should pay. R1 is unclear on the original transportation agreement verbiage as it was 2 years ago.

Documents collected by LPA showed for this event on 8/8/24, the request for transportation was made on 8/7/24 for an appointment on 8/8/24 at 10:30am and a second request made on 8/8/24 for an appointment on 8/8/24 at 1:30pm. Per facility interview, the 1:30pm appointment is when the facility told R1 they were able to take R1, but not pick R1 up, that R1 would need to use alternative transportation.

Document also obtained from the transportation binder at the facility, per facility, they requested R1 write a list of all future appointments that R1 knew about, to prevent future missed appointments. Some of the noted dates on the list were observed to be added to the transportation schedule.
The following documents note the transportation requirements set forth by the Plan of Operation, Residency Agreement (Admission Agreement) and the Resident Handbook.
The Plan of Operation (rev 12/6/23 and prior versions) state under “Basic Services (1.) …Community will ensure that medical and dental needs are met. This will include (a.) In ensuring transportation is provided, Community staff shall transport residents or make arrangement for this service with an outside transportation service…. (11.) Assistance will be given to all residents in arranging all transportation needs.”
Residency Agreement, signed by R1 states: (A.) Residential Services…” Assistance with transportation to and making arrangements for obtaining incidental medical and dental care. (1.) Living Accommodations (n.)Transportation. The Oaks at Nipomo will make available scheduled transportation to medical and dental appointments……Scheduled transportation within a twelve-mile radius of the Community is provided….. Charges for these services are set forth in Appendix B.

Continued to 9099-C

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Melisa Rankin	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20240813082147

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: 08/23/2024

NARRATIVE

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Appendix B states: “Transportation…Services” “The Community will provide a complimentary transportation on a scheduled basis….”
Resident Handbook (Rev 3/1/18) states under Transportation: “The Community provides residents scheduled transportation within the surrounding areas. Requests on appointment days are first come, first served, and are provided within a limited area. Reservations for transportation may be scheduled by notifying the Concierge.”

Copies of Residency Agreement and Appendix B were collected with R1’s signatures.
In addition, the following documents were collected from the facility; a “Welcome Home” packet sample which included a flyer “The Oaks at Nipomo Transportation Schedule” which notes …” complementary transportation to medical appointments within a 12 mile radius…” “Monday 1:00 pm – 3:30 pm (limited availability), Tuesday & Thursday 9:00 am – 4:00 pm.” With a small note “Please make sure you give at least 5 business day notice so we can make arrangements for your transportation.” Per facility this packet is given to new residents when they arrive at the facility. Also provided was a list of five alternative transportation options: Senior Go, Dial-a-Ride, Whilshire Community Services, Uber, and Lyft. All services require prior scheduling except for Uber and Lyft.

The allegation is deemed unsubstantiated at this time. Based on interviews and the facility documents obtained the facility provided ways for R1 to pre-schedule transportation requests and provides a minimum of 5 alternative transportation methods when the facility cannot assist. In this instance the resident scheduled the declined transportation on the same day as the appointment. Opportunities for R1 to take other transportation was given as an option, but due to the limited time frame and location, the only options where Uber and Lyft.

LPA provided a Technical Advisory that the facility update at minimum their “Transportation” flyer/notice to clearly define their process for transportation with expectations as to the pre-scheduling timeframe and the operating days/hours. This should be posted in common areas, and on the activity bulletin board.
Continued to 9099-C

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Melisa Rankin	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20240813082147

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: 08/23/2024

NARRATIVE

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This requirement is also listed in the facilities licensee Operating Policy. Policy Number: LIFE-009 “2. The Community will establish the regular schedule. 3. The bus schedule will be posted on the activity bulletin board.” The initial “Welcome Home” packet does not specify the “give 5 business day notice” requirement, and other documents state “scheduled” transportation which can be miss interpreted and/or forgotten after residents remain in care.

LPA also provided a Technical Advisory that facility management monitor requested scheduled transportation's to ensure a consistency is maintained when providing transportation during scheduled hours, so residents do no get accustom to schedule alterations and this type of accommodating schedules becomes an expectation.

Exit interview conducted, copy of report given.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Melisa Rankin	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024

LIC9099 (FAS) - (06/04)

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