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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850168
Report Date: 02/15/2023
Date Signed: 02/15/2023 02:50:35 PM


Document Has Been Signed on 02/15/2023 02:50 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:OAKMONT OF RIVERPARKFACILITY NUMBER:
565850168
ADMINISTRATOR:JASON RUSSOFACILITY TYPE:
740
ADDRESS:901 TOWN CENTER DRIVETELEPHONE:
(805) 940-0390
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY:140CENSUS: 92DATE:
02/15/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Chris AndersenTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Ashley Smith conducted a Case Management - Deficiencies visit due to deficiencies discovered during the investigation of complaint control number 29-AS-20220708092257. The LPA met with Executive Director Chris Andersen and explained the reason for the visit.

During the course of the investigation, it was revealed that on 07/06/2022, Staff #1 (S1) pressed their body against Resident #1 (R1) in an attempt to restrict R1’s movement and to stop R1 from hitting them. This incident took place while S1 was assisting R1 with a shower. At that time, S1 did not ask for additional assistance in showering R1, although staff was aware of R1’s agitation prior to assisting R1 with a shower. As a result of this incident, management has noted that R1 now requires a two-person assist for showers.

S1’s behavior of pressing their body against R1 in an attempt to restrict their movement is a personal rights violation. S1 could have attempted different interventions to assist R1 by way of practicing non-physical intervention methods.

Pursuant to Title 22, California Code of Regulations, the following deficiency is cited (refer to LIC 809-D).

Exit interview conducted, appeal rights discussed, and a copy of this report issued.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/15/2023 02:50 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 02/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/24/2023
Section Cited

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87468.1(a)(3) Personal Rights of Residents in All Facilities. Residents ... shall have all of the following personal rights: To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature ...
This requirement is not met as evidenced by:
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The Executive Director has agreed to do the following:
1. Management will complete an in-service training with staff, speaking to the approved guidelines staff will implement in supporting challenging behavior.
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Based on interviews and records review, the licensee did not comply with the section cited above, as S1 restricted R1's movement by pressing their body against R1, which poses a potential personal rights risk to residents in care.
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The first round of training must take place in the next two days, with all staff having received the in-service training by 2/24/2023. Submit sign-in sheet and supporting documents to CCLD.

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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: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
LIC809 (FAS) - (06/04)
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