565850168-3-3-2023-29-AS-JAPL-CQ734U-20230322175543

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850168
Report Date: 03/03/2023
Date Signed: 03/03/2023 02:34:53 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 RIVERPARK		FACILITY NUMBER:	565850168
ADMINISTRATOR:	BERGAN, KIM		FACILITY TYPE:	740
ADDRESS:	901 TOWN CENTER DRIVE		TELEPHONE:	(805) 940-0390
CITY:	OXNARD	STATE: CA	ZIP CODE:	93036
CAPACITY:	140	CENSUS: 88	DATE:	03/03/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Chris Andersen		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Staff are not showering residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elsie Campos conducted a subsequent complaint visit to deliver the findings on the the above allegations. LPA met with administrator Chris Andersen 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.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023

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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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 RIVERPARK		FACILITY NUMBER:	565850168
ADMINISTRATOR:	BERGAN, KIM		FACILITY TYPE:	740
ADDRESS:	901 TOWN CENTER DRIVE		TELEPHONE:	(805) 940-0390
CITY:	OXNARD	STATE: CA	ZIP CODE:	93036
CAPACITY:	140	CENSUS:	DATE:	03/03/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:			TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Staff are not meeting residents' incontinence needs

INVESTIGATION FINDINGS:

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Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023

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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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: 03/03/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Under Appeal Type A 03/04/2023 Section Cited CCR 87625(b)(3)	1 2 3 4 5 6 7	87625(b)(3) Managed Incontinence...the licensee shall be responsible for the following: Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Administrator agreed to do the following: 1. Submit a Plan of Action, indicating how staff will care for residents with bladder and bowel incontinence and how the facility will manage R2’s room cleanings. Submit plan of action no later than 3/6/2023.
	8 9 10 11 12 13 14	Based on interviews, record review and observation, the licensee did not comply with the section cited above, as they did not ensure residents’ incontinence was properly managed, which poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14	2. Hold an in-service training with all staff regarding regulation 87625 Managed Incontinence. Submit sign-in sheet of completed training within the next seven days, but no later than 3/11/2023.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023

LIC9099 (FAS) - (06/04)

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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: 03/03/2023

NARRATIVE

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On 2/26/23 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. Findings were delivered during today's visit.

Regarding the allegation: Staff are not meeting residents’ incontinence needs

It was alleged that staff will not help residents with going to the bathroom and yell at them for asking for help and as a result would be left in soiled diapers. Interviews with Staff #1 (S1) and Staff #2 (S2) denied claims that residents are yelled at or turned away from being helped with toileting. Interviews with facility staff confirmed residents are checked regularly approximately every two (2) hours to ensure that they are changed in a timely manner. Additional staff interviews denied claims that staff yell or fail to meet resident incontinence needs. Resident interviews revealed that some carry pendants in which the facility has failed to answer timely resulting in the residents to have to wait up to an hour or call the front desk for assistance. Staff interviews confirmed that memory care residents have called the front desk for assistance. A record review confirmed that pendants were not being answered timely. Additionally, the LPA observed Resident #2 (R2’s) room to have a heavy smell of urine upon entry and throughout the room. Interviews reveled that R2 is often soiling themselves or has accidents throughout the room as too why there is a heavy smell. The facility did not provide evidence that there are additional room cleanings scheduled for R2 based on R2’s inability to contain their urine and therefore not meeting R2’s incontinence needs. Based on the information obtained, there is sufficient evidence to support the claim that staff are not meeting residents’ incontinence needs. 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: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023

LIC9099 (FAS) - (06/04)

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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: 03/03/2023

NARRATIVE

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SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023

LIC9099 (FAS) - (06/04)

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