565850169-3-2-2023-29-AS-DPEA-CS3V6A-20230522160914

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850169
Report Date: 03/02/2023
Date Signed: 03/02/2023 06:12:06 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: 78	DATE:	03/02/2023
		UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Bradlee Foerschner		TIME COMPLETED:	06:15 PM

ALLEGATION(S):

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Facility overcharged resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint investigation for the allegation listed above. LPA arrived at the facility at 12:10PM and met with Executive Director (ED) Bradlee Foerschner. Entrance interview conducted.

During today's visit, LPA Dulek conducted an interview with ED Foerschner at 12:15PM, gathered and reviewed pertinent documents. During an initial complaint visit conducted on 12/13/2022, LPA toured the facility with Business Office Director (BOD) at 12:19PM, interviewed BOD at 12:30PM, ED Foerschner at 12:42PM, and LPA reviewed and obtained copies of pertinent documents. The following was then determined:

It was alleged that the facility overcharged Resident #1 (R1) for care services. LPA reviewed records for R1 as well as the communication between the facility and R1's representative. Record review revealed that
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: 03/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023

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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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: 03/02/2023

NARRATIVE

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when R1 moved into the facility, R1 was at a care level 1. R1 fell on 07/29/2022, which resulted in a broken hip and hospitalization. When R1 returned to the facility at the end of August, R1's care needs were increased to a level 3 during R1's recovery. Upon review, the facility did issue a credit to R1's account to reflect a lower level of care (level 2 care) and backdated the credit for the difference in the levels of care to November 1, 2022. Record review revealed R1's assessments do reflect the change in care needs and the additional care provided. Based on interview and record review, although the allegation may be valid, at this time there is insufficient evidence to support the allegation, therefore, the allegation "facility overcharged resident" is deemed UNSUBSTANTIATED at this time.

Exit interview was conducted with Executive Director. A copy of the report was provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023

LIC9099 (FAS) - (06/04)

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