<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850169
Report Date: 05/11/2023
Date Signed: 05/11/2023 10:20:31 AM


Document Has Been Signed on 05/11/2023 10:20 AM - 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 CAMARILLOFACILITY NUMBER:
565850169
ADMINISTRATOR:FOERSCHNER, BRADLEEFACILITY TYPE:
740
ADDRESS:305 DAVENPORT STREETTELEPHONE:
(805) 738-3600
CITY:CAMARILLOSTATE: CAZIP CODE:
93012
CAPACITY:150CENSUS: 77DATE:
05/11/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:48 AM
MET WITH:Bradlee FoerschnerTIME COMPLETED:
10:25 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced Case Management – Incident visit for the purpose of following up on a self-reported incident that occurred on 05/08/2023. LPA initially met with Business Office Director Kailey Vanderwall. Executive Director (ED) Bradlee Foerschner arrived at 09:00AM. LPA explained the reason for today's visit.

On 05/08/2023 at 04:10PM, LPA Dulek received a telephone call from ED Foerschner indicating Resident #1 (R1,) who resides in the Traditions unit, had made an allegation of abuse against Staff #1 (S1.) LPA requested that an incident report and suspected abuse report be sent to the Woodland Hills Regional Office (RO.) Written report was faxed and received on 05/09/2023. Additionally, ED informed LPA that notifications were made to R1's responsible party, primary care physician, the local police department, and Long Term Care Ombudsman (LTCO.)

During today's visit, LPA along with Business Office Director toured the facility at 08:51AM, interviewed ED Foerschner at 09:04AM, and LPA obtained copies of pertinent documents. No immediate health and safety hazards were identified during today's visit.

Executive Director was informed that Investigator Ryan Miles from CCLD's Investigations Branch will follow up regarding the incident.

Exit interview conducted. A copy of today's report was provided.

SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly DulekTELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:
DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/11/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1