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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850243
Report Date: 02/03/2023
Date Signed: 02/03/2023 05:11:51 PM

Substantiated


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
01/31/2023 and conducted by Evaluator Kasandra Lopez
COMPLAINT CONTROL NUMBER: 29-AS-20230131131927
FACILITY NAME:OAKMONT OF MOORPARKFACILITY NUMBER:
565850243
ADMINISTRATOR:RONDA WILKINFACILITY TYPE:
740
ADDRESS:13960 PEACH HILL DRIVETELEPHONE:
(805) 292-0700
CITY:MOORPARKSTATE: ZIP CODE:
93021
CAPACITY:112CENSUS: 51DATE:
02/03/2023
UNANNOUNCEDTIME BEGAN:
10:19 AM
MET WITH:Ronda WilkinTIME COMPLETED:
05:06 PM
ALLEGATION(S):
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Facility is in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced initial complaint inspection at the facility today. The LPA met with Administrator Ronda Wilkin at 10:25 AM and explained the reason for the inspection.

During today's inspection the LPA conducted physical plant tour along with the Administrator beginning at 10:36 AM. During tour, the LPA observed the common areas, the kitchen and dining room area, the memory care, the outside parking lot, and the basement where the movie room, gym, and activity areas are. The LPA also conducted interviews with the Administrator, four staff members, and six residents between 10:43 AM and 12:45 PM. Beginning at 1:08 PM, the LPA reviewed facility records.

Report continued on LIC 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023
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 7
Control Number 29-AS-20230131131927
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 MOORPARK
FACILITY NUMBER: 565850243
VISIT DATE: 02/03/2023
NARRATIVE
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The allegation of 'Facility is in disrepair' alleges the handicap push button to open the front door is inoperable, three (3) fireplaces in the facility are inoperable, the elevator breaks down often, and when it rains it leaks in the basement. When the LPA arrived to the facility, the LPA observed the handicap push button outside the facility to not be operable. Upon entry, the LPA also tested the inside handicap and observed it to not be operable either. The LPA also observed three fireplaces in the common areas not working during the physical plant tour. When observing the basement area the LPA did not observe any visible issues of previous leaks.

During the inspection, the Administrator confirmed there has been leaks in the past but stated they have had no evidence of mold. Administrator said past leaks have been repaired or are in the process of being fixed as currently there is a leak in the kitchen leading to the basement. Regarding the handicap push button and the fire places, the Administrator stated the handicap push button has not been operable on and off for about a month and there have issues with the fireplaces. She stated the parts for the handicap push button and the fireplaces are still under warranty and they are working on getting the issues fixed. The LPA reviewed email correspondences dated from 10/27/2022 until 02/01/2023 with the service company requesting service and repairs. Emails revealed the parts needed have been on back order since 11/01/2022. The LPA spoke with Maintenance Director Aaron Jackson and he also confirmed the fireplaces and handicap push button have been serviced and are pending parts on back order. The Administrator advised there have been no issues with the heating system and the facility is kept between 72-74 degrees F. Regarding the elevator, the Administrator and Maintenance Director stated they were advised by the elevator service tech that when residents hold the door open for too long the elevator shakes or freezes and it needs to be reset. The Administrator and the Maintenance Director stated they and several staff have access to reset the elevator. The Maintenance Director stated the elevator has needed to be reset about six times and he is working on getting another technician to access the situation.

Although, the facility is working on resolving the issues, the handicap push button and fire places are not operable at this time and the facility currently has a leak pending repair. The facility also has an ongoing issue with the elevator. Therefore, the allegation of 'Facility is in disrepair' is substantiated. Pursuant to Title 22 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 9099-D). Report reviewed with the Administrator over the telephone due to computer issues at the facility. Report and appeal rights were emailed for signature
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 7
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
01/31/2023 and conducted by Evaluator Kasandra Lopez
COMPLAINT CONTROL NUMBER: 29-AS-20230131131927

FACILITY NAME:OAKMONT OF MOORPARKFACILITY NUMBER:
565850243
ADMINISTRATOR:RONDA WILKINFACILITY TYPE:
740
ADDRESS:13960 PEACH HILL DRIVETELEPHONE:
(805) 292-0700
CITY:MOORPARKSTATE: ZIP CODE:
93021
CAPACITY:112CENSUS: 51DATE:
02/03/2023
UNANNOUNCEDTIME BEGAN:
10:19 AM
MET WITH:Ronda WilkinTIME COMPLETED:
05:06 PM
ALLEGATION(S):
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Facility has an inadequate emergency disaster plan
Staff failed to keep the facility free of pests
Facility does not provide an adequate variety of food
Facility signal system is not working properly.
There is not a safe pathway from resident parking to facility entrance
Facility does not provide adequate transportation for residents
Resident outings are cancelled without ample notice to residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced initial complaint inspection at the facility today. The LPA met with Administrator Ronda Wilkins at 10:25 AM and explained the reason for the inspection.

During today's inspection the LPA conducted physical plant tour along with the Administrator beginning at 10:36 AM. During tour, the LPA observed the common areas, the kitchen and dining room area, the memory care, the outside parking lot, and the basement where the movie room, gym, and activity areas are. The LPA also conducted interviews with the Administrator, four staff members, and six residents between 10:43 AM and 12:45 PM. Beginning at 1:08 PM, the LPA reviewed facility records.
The allegation of 'Facility has an inadequate emergency disaster plan' alleges the facility has an inadequate safety plan for evacuation that specifically addresses how residents on the basement/ground level of the facility will evacuate if the building is without power and only stairs are available.
Report continued on LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 29-AS-20230131131927
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 MOORPARK
FACILITY NUMBER: 565850243
VISIT DATE: 02/03/2023
NARRATIVE
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During the physical plant tour, the LPA observed evacuation chairs in all three stair wells which is required by Health and Safety Code 1569.695. The Administrator also showed the LPA records that staff have emergency drills quarterly and on each shift, the last being a fire drill on 12/12/2022, conducted by Fire Safety Service, Inc. Although, the Emergency and Disaster Plan for Residential Care Facilities for the Elderly (LIC 610E) posted at the entrance of the facility was not the current version of the form, the facility had the updated version LIC 610E (3/19) in the facility file with Community Care Licensing and was observed on file at the facility. The Administrator will post the updated version. Based on the information obtained, there is insufficient evidence to support the 'Facility has an inadequate emergency disaster plan'. Therefore, the allegation is deemed unsubstantiated at this time.

The allegation of 'Staff failed to keep the facility free of pests' alleges a rodent was recently observed in the dining room. During the physical plant tour, the LPA observed the kitchen and dining area beginning at 10:42 AM and met with Chef Francisco Garya. During the inspection, the LPA did not observe any evidence of pests. Mr. Garya stated we was not aware of any issues pertaining to pest in the kitchen or dining room and they receive monthly service from Ecolab Pest Elimination Division. The LPA reviewed past invoices from 1/26/2023, 12/06/2022, and 11/14/2022. All three invoices report no evidence of rodent activity. During the interviews with six residents and one dining room staff, they revealed no observation of rodents in the dining room. Based on the information obtained, there is insufficient evidence to support the allegation occurred. Therefore the allegation of Staff failed to keep the facility free of pests is deemed unsubstantiated at this time.

The allegation of 'Facility does not provide an adequate variety of food' alleges there is a sufficient variety of food and not enough healthy sides being served. The LPA observed the facility menu and the any time menu which are items available everyday in addition to the regular menu. The LPA also reviewed Consultant Dietician Report Card from December 2022. The report indicates the menu was reviewed and approved. Interviews with Mr. Garza revealed the menu changes quarterly. They also have a "Everyday Menu" available daily. Mr. Garza stated if the residents do not like the side being served with the meal, they can always request to change it to a salad, fruit, soup of the day, potato salad, cole slaw, etc.

Report continued on LIC 9099-C.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 29-AS-20230131131927
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 MOORPARK
FACILITY NUMBER: 565850243
VISIT DATE: 02/03/2023
NARRATIVE
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Interviews with the six residents revealed no issues or concerns regarding the variety of food being serviced and stated there were plenty of options to substitute if they did not like what was being served. Based on the information obtained, there is insufficient evidence to support the allegation observed. Therefore, the allegation of 'Facility does not provide an adequate variety of food' is deemed unsubstantiated at this time.

The allegation of 'Facility signal system is not working properly' alleges the signal system only alerts staff to the resident's bedrooms of the resident who called and does not alert staff where exactly the resident is at. During the inspection, the LPA used the pendent of a resident in a common area on the first floor and another one in the basement. Both alerted staff to the correct location. Residents interviewed did not reveal any issues or concerns pertaining the pendents. Based on the information obtained, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of "Facility signal system is not working properly' is deemed unsubstantiated at this time.

The allegation of 'There is not a safe pathway from resident parking to facility entrance' alleges there is not a side walk or safe path leading from the resident parking lot on the side of the building to the front of the building. LPA observed the parking lot area and front entrance of the facility. In the front of the building there are sidewalks an both sides of the front of the building with handicap access. Although, there are no side walks on the side of the building where is guest parking, the LPA did not observe any Title 22 regulation or Health and safety code violations regarding how the parking lot is set up. Also residents interviewed with vehicles had no issues or safety concerns regarding the pathway from the parking lot to the front entrance of the building. Based on the information, there is insufficient evidence to support a deficiency being observed. Therefore, the allegation of "There is not a safe pathway from resident parking to facility entrance' is deemed unsubstantiated at this time.

Report continued on LIC 9099-C.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 29-AS-20230131131927
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 MOORPARK
FACILITY NUMBER: 565850243
VISIT DATE: 02/03/2023
NARRATIVE
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The allegation of 'Facility does not provide adequate transportation for residents' and 'Resident outings are cancelled without ample notice to residents' alleges the facility only has one bus driver and if he is busy with another resident, residents need to find alternative transportation and outings are cancelled with little notice to residents. Interviews with the Administrator and the bus driver revealed two days a week are set for resident medical appointments, and the other three days a week are scheduled for outings and if outings are cancelled it is because no one signed up for the outing. The Administrator stated they currently have 51 residents and one full time bus driver. They also have a vehicle that five staff are authorized to drive. Interviews with residents revealed most residents interviewed did not use the facility bus for transportation and they do not participate in outings. Based on the information obtained there is insufficient evidence to support the allegations occurred. Therefore the allegations are deemed unsubstantiated at this time.

Exit interview and report reviewed. Report and appeal rights were reviewed over the telephone with the Administrator. A copy of the report was emailed to be signed.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 29-AS-20230131131927
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 MOORPARK
FACILITY NUMBER: 565850243
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
02/10/2023
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times.
Maintenance shall include provision of maintenance services and procedures for the safety and well-being of ...This requirement is not met as evidence by:
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The Administrator shall submit a plan by 02/10/2023 on how they will ensure resident's personal rights, and health and safety is not affected until repairs can be completed.
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Based on observation and interview, the license failed to comply with the sections cited above as the handicap push button and fire places are not functional, the facility currently has a leak, and the elevator needs to be reset frequently which poses a potential health and....continued...
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and safety and personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023
LIC9099 (FAS) - (06/04)
Page: 7 of 7