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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850169
Report Date: 10/05/2023
Date Signed: 10/05/2023 04:18:53 PM


Document Has Been Signed on 10/05/2023 04:18 PM - 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: 79DATE:
10/05/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Bradlee FoerschnerTIME COMPLETED:
02:10 PM
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 10/01/2023. LPA met with Executive Director (ED) Bradlee Foerschner. LPA explained the reason for today's visit.

On 10/02/2023, ED had called and left a voicemail message for the LPA indicating Resident #1 (R1) who resides in Traditions had been found outside about a block away from the facility. R1 does have a diagnosis of dementia and is unable to leave the facility unassisted.

During today's visit, LPA interviewed ED related to the incident, LPA along with ED toured the facility at 12:45PM, all delayed egress points were tested, and LPA obtained copies of documents pertinent to the incident. ED had informed LPA that last night, one of the delayed egress points had malfunctioned and the facility has provided staff to observe the identified gate until needed repairs are made. All other delayed egress points functioned properly during today's visit. ED indicated the written incident report related to the 10/01/2023 incident would be faxed to the Regional Office within the appropriate time frame.

LPA will return at a later date to continue the investigation into the incident that occurred once all written documentation has been received.

No citations issued. 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: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/05/2023
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