565850169-9-1-2022-29-AS-KHEN-CKBS5T-20221018133454

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850169
Report Date: 09/01/2022
Date Signed: 09/01/2022 06:38:18 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
08/23/2022 and conducted by Evaluator Kelly Dulek

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20220823162332

FACILITY NAME:	OAKMONT OF CAMARILLO		FACILITY NUMBER:	565850169
ADMINISTRATOR:	BERARD, MARTHA		FACILITY TYPE:	740
ADDRESS:	305 DAVENPORT STREET		TELEPHONE:	(805) 738-3600
CITY:	CAMARILLO	STATE:	ZIP CODE:	93012
CAPACITY:	150	CENSUS: 80	DATE:	09/01/2022
		UNANNOUNCED	TIME BEGAN:	10:17 AM
MET WITH:	Bradlee Foershner/Kailey Vanderwall		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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Facility failed to safeguard resident's belongings

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 10:17AM and met with Executive Director Bradlee Foershner. Entrance interview conducted.

During today's visit, LPA toured the facility with Executive Director 11:05AM, interviewed staff at 10:36AM and between 11:35AM to 02:15PM, LPA reviewed and obtained copies of pertinent documents. The following was then determined:

The facility had sent an Unusual Incident report to the Woodland Hills Regional Office on 08/09/2022 indicating former Resident #1 (R1) had passed away and a family member reported that personal belongings were missing from R1's room. The alleged loss occurred sometime between 08/02/2022 and 08/07/2022.

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: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

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-20220823162332

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: 09/01/2022

NARRATIVE

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During a previous in-person facility visit conducted on 08/11/2022, LPA Dulek spoke with Regional Operations Specialist Sam Faye regarding the alleged loss and corresponding incident report. Interview revealed the alleged loss had been reported to law enforcement and Camarillo Police visited the facility to take a report. During today's visit, records were reviewed, which revealed that according to R1's physician, R1 was independent in all self-care needs and was "able to manage (their) own cash resources." Upon admission to the facility, R1's Residence and Services Agreement was signed and initialed for understanding. Admission Agreement states "Oakmont shall not be responsible for the loss of any personal property belonging to you due to theft, fire, or any other cause, unless the loss or damage was caused by the negligence of Oakmont or its employees...We will provide you with a locked or secure place for personal property." Oakmont Theft and Loss Policies and Procedures reiterate statements in the Admission Agreement as well as "Oakmont will install a lock for any cabinet that the resident wishes to convert for the safekeeping of valuables." According to the incident report and interview, the alleged missing item had been left in an unlocked desk drawer in R1's room. R1's Optional Inventory of Personal Property was signed upon admission and indicates "I do not wish to inventory personal property." Therefore, there is no documented record of what personal property may have been present in R1's room during the time of the alleged loss. When Oakmont staff was made aware there may have been a loss, staff called the police and made a report to CCL, following the facility Theft and Loss program guidelines. Based on interview and record review, although the allegation may be valid, at this time there is insufficient evidence to support that a violation occurred, therefore the allegation that "facility failed to safeguard resident's personal belongings" is deemed UNSUBSTANTIATED at this time.

Exit interview was conducted with Business Office Director Kailey Vanderwall. 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: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

LIC9099 (FAS) - (06/04)

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