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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850168
Report Date: 02/16/2023
Date Signed: 02/16/2023 05:51:04 PM

Unsubstantiated


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
06/28/2022 and conducted by Evaluator Elsie Campos
COMPLAINT CONTROL NUMBER: 29-AS-20220628083047
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: 93DATE:
02/16/2023
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Sheila Memory Care DirectorTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Staff denied resident food
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elsie Campos conducted a subsequent complaint visit to investigate the above allegations. LPA met with Memory Care Director Sheila Ramirez and explained the reason for the visit.
On 07/01/2022, from 9:30am to 12:38pm, Licensing Program Analysts (LPAs) Teresa Camara and Elsie Campos conducted the initial complaint visit. LPAs Camara and Campos met with Memory Care Director Sylvia Williams, LVN; at 10:55am, LPAs conducted an interview with a visitor. At approximately 10:15am, LPAs conducted a brief tour of memory care and the main lobby area of the facility. LPAs obtained pertinent documents at approximately 12:15pm. LPAs determined further investigation was needed prior to issuing findings. On 1/17/2023 LPA Campos conducted a subsequent visit. LPA Campos met with Memory Care Director Sheila Ramirez at 11:15 a.m. LPA conducted an interview with staff at 11:40 a.m., 12:25 p.m., 1:25 p.m. 2:40 p.m., 3:05 p.m. and 4:08 p.m. The LPA obtained pertinent documents at approx. 1:30 p.m. Further investigation is needed prior to issuing findings.
Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie CamposTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
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-20220628083047
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: 02/16/2023
NARRATIVE
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During today’s visit LPA Campos met with Memory Care Director Sheila Ramirez at approximately 9:50 a.m., obtained pertinent documents, interviewed staff at 12:30 p.m., 12:58 p.m., 1:18 p.m. and 1:35 p.m., 2:20 p.m. and 3:27 p.m. interviewed residents at 11:15 a.m., 11:23 a.m., 11:27 a.m. and 3:16 p.m.

Regarding the allegation: Staff denied resident food

The complainant alleged that staff do not feed the residents and if a resident sleeps through breakfast and asks for food staff will refuse to serve them. Staff interviews denied the allegation that residents are not fed or denied food if they arrive after mealtimes. Staff confirmed that some residents will come back after they just ate because they forgot they had eaten and will redirect them after explaining they had just ate. Staff interviews revealed that all residents are offered a meal and any residents who do not arrive for the meal hour will have their food set aside until they arrive. The LPA observed the dining room area in Memory Care and confirmed that plates were set aside for those residents who did not arrive for their meal. The LPA additionally observed residents arriving after the designated meal hour and saw that they were seated and given their plate of food. Interviews with residents did not reveal any concerns regarding meals not being served after meal hours or not being fed. Interviews with residents revealed that if they are hungry, they can have a snack. Based on the information obtained, there is insufficient evidence to support the claim that staff denied resident food. This allegation is deemed Unsubstantiated at this time.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie CamposTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
LIC9099 (FAS) - (06/04)
Page: 2 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
06/28/2022 and conducted by Evaluator Elsie Campos
COMPLAINT CONTROL NUMBER: 29-AS-20220628083047

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: 93DATE:
02/16/2023
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Sheila Memory Care DirectorTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Staff are not responding timely to residents' call buttons
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elsie Campos conducted a subsequent complaint visit to investigate the above allegations. LPA met with Memory Care Director Sheila Ramirez and explained the reason for the visit.
On 07/01/2022, from 9:30am to 12:38pm, Licensing Program Analysts (LPAs) Teresa Camara and Elsie Campos conducted the initial complaint visit. LPAs Camara and Campos met with Memory Care Director Sylvia Williams, LVN; at 10:55am, LPAs conducted an interview with a visitor. At approximately 10:15am, LPAs conducted a brief tour of memory care and the main lobby area of the facility. LPAs obtained pertinent documents at approximately 12:15pm. LPAs determined further investigation was needed prior to issuing findings. On 1/17/2023 LPA Campos conducted a subsequent visit. LPA Campos met with Memory Care Director Sheila Ramirez at 11:15 a.m. LPA conducted an interview with staff at 11:40 a.m., 12:25 p.m., 1:25 p.m. 2:40 p.m., 3:05 p.m. and 4:08 p.m. The LPA obtained pertinent documents at approx. 1:30 p.m. Further investigation is needed prior to issuing findings.
Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie CamposTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20220628083047
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: 02/16/2023
NARRATIVE
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During today’s visit LPA Campos met with Memory Care Director Sheila Ramirez at approximately 9:50 a.m., obtained pertinent documents, interviewed staff at 12:30 p.m., 12:58 p.m., 1:18 p.m. and 1:35 p.m., 2:20 p.m. and 3:27 p.m. interviewed residents at 11:15 a.m., 11:23 a.m., 11:27 a.m. and 3:16 p.m.
Regarding the allegation: Staff are not responding timely to residents’ call buttons
On 02/16/2023, starting at 3:16 p.m., LPA interviewed Resident #1 (R1). Interview with R1 revealed that they have a pendant that isn’t always answered timely. R1 stated, it takes more than 10 -15 minutes or more for staff to answer the pendant call for help. LPA had R1 press the pendant at 3:16 p.m., again at 3:19 p.m. and one last time at 3:22 p.m. no one answered the call until 3:24 p.m. when a staff notified of the pendant over the walkie. Interview with Memory Care Director Sheila Ramirez on 2/16/2023, revealed that staff are supposed to be responding right away. Sometimes staff are busy with other residents and cannot answer however it should not take them more than 5 minutes to respond. R1 has a working pendant. It was communicated that staff have pagers that receive notification in both memory care (MC) and assisted living (AL). When the call is not answered by MC it is answered by AL, who then walkies MC to answer the call.

On 2/16/2023, starting at 1:30 p.m., LPA Campos reviewed the SMARTcare Alert Call Button report for Resident #1 (R1). Regarding R1, it was indicated that there were nine (9) instances where R1 pressed their pendant between February 11th and February 16th 2023, there was one (1) alert that staff received and responded to at 37 minutes but failed to respond to the the other eight (8) alerts at all. R1 confirmed that they are often left for long periods of time waiting on a response after pressing their pendant. R1 will sometimes call the front desk with their personal phone to request that someone come help them as no has answered their pendant notification. Staff interviews confirmed that R1 will call the front desk for assistance if they have not been helped timely. Additionally, LPA Campos reviewed the SMARTcare Alert Call Button report for Resident #2 (R2). Regarding R2, it was indicated that there were ten (10) instances where R2 pressed their pendant between February 11th and February 16th 2023, there was three (3) alerts that staff received and responded to timely and two (2) alerts in which staff responded between (twenty) 20 to (fourty-four) 44 minutes after but failed to respond to the other five (5) alerts at all. As a result, the provided logs may not fully represent the time(s) in which R1 and R2 required assistance, or when R1 or R2 was without a button and still required assistance.

Based on the information from the investigation, there is sufficient evidence to support the claim that staff are not responding to residents’ call buttons in a timely manner. Based on record review and interview, the allegation is Substantiated at this time.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie CamposTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Citations on this Visit Report are Under Appeal!

Control Number 29-AS-20220628083047
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: 02/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
02/24/2023
Section Cited
CCR
87468.1(a)(2)
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87468.1 Personal Rights of Residents in All Facilities (a)(2) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
This requirement is not met as evidenced by:
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The Memory Care Director agreed to the following:
1. Review policies and procedures around responding to pendants. Send sign-in sheet to CCL no later than 2/24/2023.
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Based on record review and interviews, the licensee did not comply with the section cited above the staff did not respond to R1 and R2's calls for assistance in a timely manner, which poses a potential personal risk to persons 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: Elsie CamposTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5