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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850168
Report Date: 09/23/2025
Date Signed: 09/23/2025 03:14:23 PM

Substantiated


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
09/18/2025 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20250918145410
FACILITY NAME:OAKMONT OF RIVERPARKFACILITY NUMBER:
565850168
ADMINISTRATOR:KAILEY VANDERWALLFACILITY TYPE:
740
ADDRESS:901 TOWN CENTER DRIVETELEPHONE:
(805) 940-0390
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY:140CENSUS: 86DATE:
09/23/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kailey VanderwallTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff did not ensure resident's room was free of pests
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Esther Cortez conducted an unannounced initial 10-day complaint visit for the above allegations. Upon arrival, LPA met with the Executive Director (ED) Kailey Vanderwall, and was explained the reason for the visit. Entrance interview conducted.

During today's inspection, between 10:00 a.m. and 3:00 p.m., the LPA interviewed the Executive Director, two (2) staff, three (3) residents, conducted observations, a file review, tested two residents emergency call button in their restroom. and obtained copies of resident records and other pertinent documents relevant to the investigation.

Report will continue on LIC9099-C, 2nd page.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025
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 4
Control Number 29-AS-20250918145410
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: OAKMONT OF RIVERPARK
FACILITY NUMBER: 565850168
VISIT DATE: 09/23/2025
NARRATIVE
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On the allegation, “Staff did not ensure resident's room was free of pests” it is the concern of the Reporting Party (RP) that there is ants in Residents #1’s (R1’s) room and they have sprayed but there is still ants in the room. Staff interviews revealed that ants in R1's room have been reported and maintenance wiped the ants down, however the room was not sprayed. Additionally staff interviews revealed ants have been seen in resident rooms including R1’s room, they have reported but do not know if maintenance sprays or not because they continue to see them. Additionally, staff have seen ants on residents’ bodies. LPA reviewed records and observed that on 09/02/25, a work order had been completed regarding ants in R1's room. During today’s visit the LPA observed multiple ants (30+) along the window in R1’s room, and more along the bottom wall frame. Based on interviews and observation there is sufficient evidence to support that “Staff did not ensure resident's room was free of pests”; therefore, this allegation is deemed SUBSTANTIATED.

The following deficiency was cited from the CA Code of Regulations, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview held, appeal rights and report copy provided

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20250918145410
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: OAKMONT OF RIVERPARK
FACILITY NUMBER: 565850168
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
10/03/2025
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in god repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
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The ED has agreed to ensure third party pest control vendor comes to spray specifically for ants outside and internernally as needed and ensure R1's rooms gets serviced. Additionally staff in-service will be conducted. Proof of third party services and staff in-service will be submitted to LPA
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This requirement was not met as evidence by: Based on interviews and observations, there is ants in R1's room, even after attempts of cleaning them which poses a potential health and safety risk to persons in care.
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BY POC due date.
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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: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4