565850169-12-13-2022-29-AS-DPEA-CS3V6B-20230522160915

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850169
Report Date: 12/13/2022
Date Signed: 12/13/2022 02:36:01 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
12/06/2022 and conducted by Evaluator Kelly Dulek

COMPLAINT CONTROL NUMBER: 29-AS-20221206154636

FACILITY NAME:	OAKMONT OF CAMARILLO		FACILITY NUMBER:	565850169
ADMINISTRATOR:	FOERSCHNER, BRADLEE		FACILITY TYPE:	740
ADDRESS:	305 DAVENPORT STREET		TELEPHONE:	(805) 738-3600
CITY:	CAMARILLO	STATE: CA	ZIP CODE:	93012
CAPACITY:	150	CENSUS: 76	DATE:	12/13/2022
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Bradlee Foerschner		TIME COMPLETED:	02:35 PM

ALLEGATION(S):

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Illegal eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek conducted an initial complaint investigation for the allegation listed above. LPA arrived at the facility at 12:15PM and initially met with Business Office Director (BOD) Kailey Vanderwall. Executive Director (ED) Bradlee Foerschner joined LPA and Ms. Vanderwall at 12:42PM. Entrance interview conducted.

During today's visit, LPA toured the facility with BOD at 12:19PM, interviewed BOD at 12:30PM, ED Foerschner at 12:42PM, and LPA reviewed and obtained copies of pertinent documents. No immediate health and safety hazards were observed during facility tour. The following was then determined:

The complaint alleges that Resident #1 (R1) was served an illegal eviction. On 12/01/2022, LPA Kelly Dulek had received an email from ED Foerschner indicating the facility served a "Quit or Pay" notice for R1, as the

Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

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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Control Number 29-AS-20221206154636

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 CAMARILLO	FACILITY NUMBER: 565850169
	VISIT DATE: 12/13/2022

NARRATIVE

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resident had an unpaid balance. A copy of the letter addressed to R1 and their POA was received in the Woodland Hills Residential Office on 12/07/2022. Facility provided proof of certified mail sent on 12/01/2022 to R1's POA and R1 signed that they received the notice in person on 12/01/2022. The notice indicates payment must be made in full by 30 days from the date of the letter or "your residency will terminate." LPA reviewed the "30-Day Notice to Pay or Quit" and confirmed the notice does contain the required language, contact information for the required parties, as well as referrals for alternate care, per regulation. The notice was served on 12/01/2022, which is 30 days from the date in which the notice indicates R1's residency will terminate if payment is not received. During today's visit, LPA confirmed R1's POA did issue a check to the facility for the past due amount which was reflected in R1's ledger on 12/12/2022. Interview revealed that R1 had previously given the facility notice to vacate, with a proposed move-out date of 10/01/2022 and has since extended that notice with no new proposed move out date scheduled. LPA observed R1 in the facility during today's visit. Therefore, based on interview and record review, although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred; as thus, the allegation "illegal eviction" is deemed UNSUBSTANTIATED at this time.

Exit interview conducted with ED Foerschner. A copy of the report was provided via email.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

LIC9099 (FAS) - (06/04)

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