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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405809547
Report Date: 09/03/2025
Date Signed: 09/03/2025 04:59:44 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
08/27/2025 and conducted by Evaluator Melisa Rankin
COMPLAINT CONTROL NUMBER: 29-AS-20250827080301
FACILITY NAME:OAKS AT NIPOMO, THEFACILITY NUMBER:
405809547
ADMINISTRATOR:RONALD C. FREEMANFACILITY TYPE:
740
ADDRESS:177 MARY AVENUETELEPHONE:
(805) 723-5206
CITY:NIPOMOSTATE: CAZIP CODE:
93444
CAPACITY:122CENSUS: 98DATE:
09/03/2025
UNANNOUNCEDTIME BEGAN:
12:23 PM
MET WITH:Ronald FreemanTIME COMPLETED:
05:05 PM
ALLEGATION(S):
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Facility failed to follow reporting requirements
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rankin conducted a required 10-day complaint visit to the above facility. LPA met with Administrator Ron Freeman and explained the purpose of the visit.

LPA was notified of possible outbreak on August 21st via correspondence with the Administrator. The administrator stated in correspondence that the county has also been contacted, and he was waiting for a response. During the complaint visit LPA interviewed the administrator, Memory care director, 10 staff, and 8 residents. LPA toured common area of the facility while speaking with staff and residents.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
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 5
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
08/27/2025 and conducted by Evaluator Melisa Rankin
COMPLAINT CONTROL NUMBER: 29-AS-20250827080301

FACILITY NAME:OAKS AT NIPOMO, THEFACILITY NUMBER:
405809547
ADMINISTRATOR:RONALD C. FREEMANFACILITY TYPE:
740
ADDRESS:177 MARY AVENUETELEPHONE:
(805) 723-5206
CITY:NIPOMOSTATE: CAZIP CODE:
93444
CAPACITY:122CENSUS: 98DATE:
09/03/2025
UNANNOUNCEDTIME BEGAN:
12:23 PM
MET WITH:Ronald FreemanTIME COMPLETED:
05:05 PM
ALLEGATION(S):
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9
Facility failed to follow infection control regulations.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rankin conducted a required 10-day complaint visit to the above facility. LPA met with Administrator Ron Freeman and explained the purpose of the visit.

LPA was notified of possible outbreak on August 21st via correspondence with the Administrator. Administrator stated in correspondence that the county has also been contacted and he was waiting for a response. During the complaint visit LPA interviewed the administrator, Memory care director, 10 staff, and 8 residents. LPA toured common area of the facility while speaking with staff and residents

On the allegation: Facility failed to follow infection control regulations.

It was alleged that the facility had residents experiencing similar symptoms of illness at the facility on August 21st and that the facility did not adhere to infection control requirements to prevent further spread. It was confirmed through a fecal testing on August 27th that a resident was positive for Norovirus. continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20250827080301
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: 09/03/2025
NARRATIVE
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Interview with the administrator and a director were done. Facility had reached out to the public health; first attempt was done on August 21st. Director stated they had been in contact with a public health Registered Nurse (RN), email provided shows that on Monday August 25th RN provided facility with basic information about the “Noro” (Norovirus). Email provided “specific cleaning suggestions.”

LPA interviewed 8 residents in the assisted living side. While speaking with residents, 7 out of 8 stated that there have been no changes to schedules, dining processes, activities, and cleaning schedules. Residents interviewed were participating in bingo, sitting in the common halls, and in the dining room. All residents during discussion stated that this is where they usually sit, eat, or this is the activity they love to do. Allowing the LPA to understand that these common areas are part of their regular schedule. All residents stated none of their activities or day to day schedules have been changed over the past 2 – 3 weeks.

LPA interviewed 10 staff, 7 of the staff work in the assisted living areas and 3 work in memory care unit. All staff stated that no changes to schedules have been made. 8 out of 10 staff stated that no changes to cleaning have been initiated, no extra cleaning requested, all stated it has been the same schedule and process as usual for the past 2 weeks. The two staff who stated that cleaning was increased were in the kitchen area and stated that cleaning to chair handrails and tables had increased starting around the 25th through the weekend of the 30th.

While the residents and staff did adhere to isolating residents with symptoms, and as of today the illness was contained and only 7 – 9 residents had displayed symptoms, and one tested positive for a contagious disease, based on interviews and provided documents, the facility did not comply with the regulations 87470 Infection Control Requirements “(b) In addition to subsection (a), when one or more residents in the facility are diagnosed with a contagious disease, the following shall apply: (1) In addition to the requirements of subsection (a)(2), assigned staff …regardless of having direct contact with residents, shall be required to perform enhanced environmental cleaning and disinfection to maintain a safe and sanitary environment and to prevent, contain, and mitigate the transmission of the contagious disease.” the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED.

Copy of report printed along with copy of appeal rights.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20250827080301
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/03/2025
Section Cited
CCR
87470(b)(1)
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87470 Infection Control Requirements (b) In addition to subsection (a), when one or more residents in the facility are diagnosed with a contagious disease, the following shall apply: (1) In addition to the requirements of subsection (a)(2), assigned staff …regardless of having direct contact with residents, shall be required to perform enhanced environmental cleaning and disinfection to maintain a safe and sanitary environment and to prevent, contain, and mitigate the transmission of the contagious disease.
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Administrator agrees the Infection Control policies will be reviewed with all directors and supervisors within the facility. Administrator will provide LPA with a current copy of the Infection Control Policy for facility.
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This requirement has not been met as evidenced by: Based on multiple interviews, 8 out of 10 staff and 7 out of 8 residents stated no addtional cleaning was observed or requested possing a potential health and safety risk to the residents in care.
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Administrator will also provide LPA with a copy of the requirements reviewed with supervisors and directors of their expectation when an outbreak or potential outbreak occurs.
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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.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20250827080301
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: 09/03/2025
NARRATIVE
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On the allegation: Facility failed to follow reporting requirements

On August 21st at 8:51am the administrator contacted LPA to inform LPA of a possible outbreak, with symptoms of vomiting and diarrhea. The administrator included in correspondence that the county had been called, and he was waiting for a call back.

The requirement of reporting possible outbreak to Community Care Licensing was done as required. When a positive test was done on August 27th to show the outbreak was Norovirus, there was only one resident symptomatic, and no additional cases occurred after that. LPA and administrator discussed that any future concerns, the same notification will be made to initiate the concern of a possible outbreak, and communication stating a positive test result has been received will be provided to licensing, even if it is only one case.

Based on interviews conducted, and record reviews, at this time the preponderance of evidence standard has not been met; therefore, the above allegation is found to be UNSUBSTANTIATED.

Exit interview conducted and copy of report provided to administrator.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5