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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850168
Report Date: 07/01/2022
Date Signed: 07/01/2022 04:57:02 PM

Substantiated


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
06/27/2022 and conducted by Evaluator Teresa Camara
COMPLAINT CONTROL NUMBER: 29-AS-20220627090021
FACILITY NAME:OAKMONT OF RIVERPARKFACILITY NUMBER:
565850168
ADMINISTRATOR:BERGAN, KIMFACILITY TYPE:
740
ADDRESS:901 TOWN CENTER DRIVETELEPHONE:
(805) 940-0390
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY:140CENSUS: 95DATE:
07/01/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Amber SilvermanTIME COMPLETED:
12:38 PM
ALLEGATION(S):
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Facility does not have contact information for Ombudsman posted
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Teresa Camara and Elsie Campos conducted an initial complaint visit regarding the above noted allegation. LPAs met with Memory Care Director (MCD) Amber Silverman, LVN and explained the reason for the visit. Executive Director Kim Bergan was out during the visit.

At approximately 09:35 a.m. LPAs met with the MCD, at 10:05 a.m. LPAs interviewed Resident 1 (R1), at 10:29 a.m. LPAs met with Health Services Diretor Sylvia Williams, LVN, at 10:55 a.m. LPAs conducted an interview with a visitor. At approximately 10:15 a.m. LPAs conducted a brief tour of memory care and the main lobby area of the facility. LPAs observed an Ombudsman poster in the assisted living activity room but no poster in memory care where memory care residents can see the poster. Based on observations, the above noted allegation is deemed Substantiated at this time. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D). Exit interview conducted. Report emailed to MCD and Administrator.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2022
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-20220627090021
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: OAKMONT OF RIVERPARK
FACILITY NUMBER: 565850168
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/08/2022
Section Cited
CCR
87468.2(a)(10)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities. The licensee shall post the telephone numbers and addresses for the local offices of the ...ombudsman program... conspicuously in the facility foyer, lobby, residents’ activity room, or other location easily accessible to residents
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Licensee will ensure there is an Ombudsman poster in the memory care unit and provide evidence of the posting to CCL on or before 07/08/2022.
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This requirement is not met as evidenced by:
Based on observation, the licensee did not comply with the section cited above, as the Ombudsman poster was not observed in the memory care unit where memory care residents would be able to observe the poster, which poses a potential health and safety risk to residents in care.
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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.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2022
LIC9099 (FAS) - (06/04)
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