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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850168
Report Date: 05/04/2023
Date Signed: 01/29/2024 05:07:33 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
07/29/2022 and conducted by Evaluator Teresa Camara
COMPLAINT CONTROL NUMBER: 29-AS-20220729163942
FACILITY NAME:OAKMONT OF RIVERPARKFACILITY NUMBER:
565850168
ADMINISTRATOR:ERIC MENSAHFACILITY TYPE:
740
ADDRESS:901 TOWN CENTER DRIVETELEPHONE:
(805) 940-0390
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY:140CENSUS: 90DATE:
05/04/2023
UNANNOUNCEDTIME BEGAN:
11:52 AM
MET WITH:Chris AndersenTIME COMPLETED:
05:27 PM
ALLEGATION(S):
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Facility staff are not reporting all of resident's falls
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint visit to address the above noted allegations. LPA met with Executive Director (ED) Chris Andersen and explained the reason for the visit.

On 8/5/2022, LPA conducted an initial complaint investigation visit. During that visit LPA interviewed staff, a witness and reviewed records between 10:00 a.m. to 12:30 p.m. On 11/29/2022, LPA conducted a subsequent complaint visit. During that visit LPA interviewed staff between 4:00 p.m. to 4:54 p.m. During today's visit, 5/4/2023, LPA conducted records review and staff interview between 12:15 p.m. to 3:40 p.m.

On 1/29/2024, LPA conducted a subsequent visit to deliver an amended report as findings on one of the allegations in the original report was incorrect.
(continued on 9099-C, page 2)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
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
Control Number 29-AS-20220729163942
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
VISIT DATE: 05/04/2023
NARRATIVE
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(continued from 9099, page 1)


Regarding the allegation: Facility staff are not reporting all of resident's falls

During LPA's review of facility records for Resident 1 (R1), LPA found in the Care Notes that R1 had falls on 7/17/2022, 7/19/2022, 7/20/2022, and 7/28/2022. R1 was taken to the urgent care on 7/19/2022 and the hospital on 7/28/2022 by R1's family. Records indicate R1's family and physician were notified of these falls, however none of these falls were reported to Community Care Licensing (CCL). Therefore, this allegation is deemed substantiated at this time.


Pursuant to Title 22, California Code of Regulations, the following deficiency is cited (refer to LIC 9099-D).

Exit interview conducted, appeal rights discussed, and a copy of this report issued.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20220729163942
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: 05/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
05/11/2023
Section Cited
CCR
87468.1(a)(1)
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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons.
This requirement is not met as evidenced by:
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Licensee will train all staff on expectations of providing care and supervision to residents and not allowing personal distractions such as purusing their personal cell phones while at work. Licensee will provide evidence of training to CCL on or before 5/11/2023.
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Based on interviews with witnesses, staff and management, the licensee did not comply with the section cited above. Staff were observed on their personal phones rather than attending to residents, which poses a potential health and safety risk to residents in care.
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Type B
05/11/2023
Section Cited
CCR
87211(a)(1)(D)
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87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence...(D) Any incident which
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Licensee will train staff on reporting requirements and provide evidence of training to CCL on or before 5/11/2023.
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threatens the welfare, safety or health of any resident... This requirement was not met as evidenced by: Based on records review, R1 had multiple falls in July 2022 and was taken for medical care twice due to the falls, however these falls were not reported to CCL, 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: Desaree PereraTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
07/29/2022 and conducted by Evaluator Teresa Camara
COMPLAINT CONTROL NUMBER: 29-AS-20220729163942

FACILITY NAME:OAKMONT OF RIVERPARKFACILITY NUMBER:
565850168
ADMINISTRATOR:ERIC MENSAHFACILITY TYPE:
740
ADDRESS:901 TOWN CENTER DRIVETELEPHONE:
(805) 940-0390
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY:140CENSUS: 90DATE:
05/04/2023
UNANNOUNCEDTIME BEGAN:
11:52 AM
MET WITH:Chris AndersenTIME COMPLETED:
05:27 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff over-medicated resident to prevent resident from ambulating.
Staff did not assist resident with ambulating as needed.
Staff did not assist resident with showering as needed.
Staff did not assist resident with changing undergarments as needed.
Facility staff are distracted by their personal phones and not meeting the needs of residents
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint visit to address the above noted allegations. LPA met with Executive Director (ED) Chris Andersen and explained the reason for the visit.

On 8/5/2022, LPA conducted an initial complaint investigation visit. During that visit LPA interviewed staff, a witness and reviewed records between 10:00 a.m. to 12:30 p.m. On 11/29/2022, LPA conducted a subsequent complaint visit. During that visit LPA interviewed staff between 4:00 p.m. to 4:54 p.m. During today's visit, 5/4/2023, LPA conducted records review and staff interview between 12:15 p.m. to 3:40 p.m.

On 1/29/2004, LPA conducted a subsequent visit to deliver an amended report as findings on one of the allegations in the original report was incorrect.
(continued on 9099-C, page 2)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20220729163942
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
VISIT DATE: 05/04/2023
NARRATIVE
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(continued from 9099-A, page 1)
Regarding the allegation: Staff over-medicated resident to prevent resident from ambulating. LPA reviewed medication records and care notes for resident 1 (R1). Medications appeared to be given as prescribed. R1 was prescribed some medications that could make R1 seem sedated at times. If staff observed R1 seemed overly drowsy, certain medications would be withheld and R1's physician was notified. Staff would request direction from R1's physician regarding administration of medications that may make R1 drowsy when R1 seemed overly tired or sedated. There was no indication R1 was being given these types of medications when not needed. Therefore, this allegation is deemed unsubstantiated at this time.

Regarding the allegation: Staff did not assist resident with ambulating as needed. LPA reviewed records for R1 and resident 2 (R2). R1's assessments and individualized service plan did not indicate R1 needed escorting or assistance from staff to ambulate. R1 was known by staff to be quite independent. R2's assessments and individualized service plan did not indicate a need for escorting. The memory care director had updated R2's service plan on 8/31/2022, however R2's family had not had an opportunity to review the proposed new services which included escorting to meals. In addition, while the MCD felt escorting was recommended it was not deemed an urgent change. Since escorting was not deemed urgent and the MCD still needed to go over the new service plan with R2's family, the escorting had not been implemented on 9/1/2022 when R2 fell at the facility. Therefore, this allegation is deemed unsubstantiated at this time.

Regarding the allegations: Staff did not assist resident with showering as needed. and Staff did not assist resident with changing undergarments as needed. LPA reviewed facility assessments and individualized service plans for R1. It was found that R1 was capable of changing clothing, using the bathroom and taking a shower on their own; R1 was said to only need reminders, set up and prompting. During interviews with staff it was stated that although R1 was in the memory care unit, R1 was very independent for most things. R1 resisted taking a shower, even if staff tried to assist R1 in the shower. R1 would become combative with staff. They tried different techniques to encourage R1 to take a shower. When R1 needed to change clothing or undergarments, staff would set out clean garments for R1 to put on but R1 did not want or need assistance with changing garments. Therefore, these allegations are deemed unsubstantiated at this time.

Regarding the allegation: Facility staff are distracted by their personal phones and not meeting the needs of residents. During LPA's interviews with the MCD, staff and a witness, it was stated that more than one staff in the memory care unit had been observed browsing their personal cell phones. The MCD notified staff they should not be on their personal phones while working. There was no evidence that staff failed to meet residents' needs. There is no regulation preventing the use of personal phones by staff. Therefore, this allegation is deemed unsubstantiated at this time.

Exit interview conducted, appeal rights discussed, and a copy of this report issued.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5