565850169-6-21-2024-29-AS-KHEN-D6NUCS-20240628152826

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850169
Report Date: 06/21/2024
Date Signed: 06/21/2024 05:05:38 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
09/21/2022 and conducted by Evaluator Kelly Dulek

COMPLAINT CONTROL NUMBER: 29-AS-20220921163357

FACILITY NAME:	OAKMONT OF CAMARILLO		FACILITY NUMBER:	565850169
ADMINISTRATOR:	FAYE, SAM		FACILITY TYPE:	740
ADDRESS:	305 DAVENPORT STREET		TELEPHONE:	(805) 738-3600
CITY:	CAMARILLO	STATE: CA	ZIP CODE:	93012
CAPACITY:	150	CENSUS: 78	DATE:	06/21/2024
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Mark Cortes & Matt Ryan		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident sustained injury while in care.
Staff do not respond to call button in a timely manner.
Staff did not seek medical attention in a timely manner.
Facility is in disrepair.
Staff are not trained for the job assigned to them.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint investigation for the allegations listed above. LPA arrived at the facility at 04:00PM and met with Executive Director (ED) Mark Cortes and Regional Operations Specialist Matt Ryan. Entrance interview conducted.

During the initial complaint visit on 09/22/2022, LPA interviewed ED Foerschner at 11:40AM, toured the facility with Executive Director 12:25PM, and LPA reviewed and obtained copies of pertinent documents. During a subsequent complaint visit on 05/22/2024, LPA spoke with Regional Memory Care Specialist Lena Gutierrez, interviewed staff from 11:17AM to 01:15PM. LPA also reviewed pertinent documents and toured the facility's Memory Care unit with Regional Memory Care Specialist at 02:10PM. Throughout the course of the investigation, LPA interviewed additional staff both telephonically and in person and LPA reviewed all pertinent documents. The following was then determined:

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: 06/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 29-AS-20220921163357

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: 06/21/2024

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
26
27
28
29
30
31
32

Allegation “Resident sustained injury while in care:”
It was alleged that due to lack of care and supervision, Resident #1 (R1) fell and sustained an injury while in care. Record review revealed that R1 was admitted to the facility on 07/18/2022. R1’s physician’s report upon admit indicated R1 was ambulatory and had a diagnosis of vascular dementia; care plan assessment indicated that R1 “wanders only within the common areas of the secured community.” Incident report reviewed revealed that R1 sustained a fall on 07/31/2022, resulting in a hip fracture. According to incident report, staff and family member interview, R1 was sitting in a chair in the Memory Care outdoor area. R1 scooted their chair out and into a recessed garden bed, resulting in R1 losing their balance and falling as they attempted to stand up. At the time of the fall, R1 did not require 1:1 supervision, nor did R1 require an escort when ambulating about the secure memory care unit. Incident report and staff interview revealed that staff were nearby when the fall occurred, and that staff followed the proper protocol for obtaining additional medical care and reporting the incident. Therefore, based on interview and record review, there is insufficient evidence to support the allegation or that a violation occurred; the allegation that “resident sustained injury while in care” is deemed UNSUBSTANTIATED at this time.

Allegation “Staff do not respond to call button timely:”

It was alleged that on occasion, R1’s family member stayed at the facility with R1 overnight and that R1’s call button was not responded to timely. LPA reviewed Care Point Server records for R1. Record review revealed response times recorded within the identified appropriate time frame reported by facility staff. Interview revealed that there are few residents in the Memory Care unit utilizing the pendant call system. When a resident presses the pendant, the alerts go to the front desk console as well as the staff pagers. Staff then will respond to the resident’s room for assistance. Interview revealed that there are times when staff are busy with other residents, but that the staff work together and communicate with one another to ensure all calls and residents’ needs are met timely. During facility visits throughout the complaint inspection, LPA observed staff tending to residents’ needs and no additional residents identified any concerns related to timeliness. Based on interview, observation, and record review revealed that at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that “staff do not respond to call button timely” is deemed UNSUBSTANTIATED at this time.

Allegation “Staff do not seek medical attention timely:”

The complaint alleges that a witness observed another resident (Resident #2 – R2) who resides in Memory
Care sitting outside on the patio and according to the complaint, R2 appeared overheated and in need of Report Continued on LIC 9099-C

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20220921163357

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: 06/21/2024

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
26
27
28
29
30
31
32

medical care. LPA spoke with facility Management as well as facility staff that were present at the time of the alleged incident. Staff indicated that R2 enjoys sitting outside in the fresh air and in the sun. On the date of the alleged incident, according to staff interviewed, R2 had not been outside for longer than about 15 to 20 minutes when staff escorted R2 back inside. R2 was tired when staff brought them back into the facility, so staff assisted R2 to bed. There was no medical treatment necessary for R2 relating to their time spent outside and therefore no incident report was needed. LPA observed R2 in the facility during the initial complaint visit; R2 appeared happy and healthy. Based on interview and observation, there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that “staff do not seek medical attention timely” is deemed UNSUBSTANTIATED at this time.

Allegation “Facility in disrepair:”

The complaint alleges that the sensors in R1’s room are non-functional. LPA reviewed motion sensor logs for R1’s room for the relevant time period, which did indicate multiple reports of motion in R1’s room. During the initial compliant visit, LPA tested the motion sensors in R1’s room and they were functional at the time of the visit. Staff interviewed indicated that R1’s motion sensors do function. LPA toured the facility during the initial complaint visit and both subsequent complaint visits, as well as multiple other unrelated visits throughout the course of the investigation and no concerns were observed during any visits. Based on interview, record review, and observation, there is insufficient evidence to support the allegation or that a violation occurred, therefore the allegation that “facility is in disrepair” is deemed UNSUBSTANTIATED at this time.

Allegation “Staff are not trained for the job assigned to them:”

The complaint alleges that new staff are not trained properly and therefore are unable to care for the residents. LPA reviewed training logs for various facility staff, including medication technicians and care staff. Interviews revealed that the facility utilizes computer training, including videos and quizzes as well as shadowing and in-person training prior to staff working in the facility with residents. Residents interviewed indicated their needs are met, and that staff are providing adequate care. Training records reviewed revealed that staff are trained in accordance with regulation. Based on interview and record review, there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that “staff are not trained for the job assigned to them is deemed UNSUBSTANTIATED at this time.

No citations issued. Exit interview conducted. A copy of today’s 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: 06/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3