567609831-8-22-2025-29-AS-KHEN-DKZUMG-20250829154219

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567609831
Report Date: 08/22/2025
Date Signed: 08/22/2025 11:27:47 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
07/23/2025 and conducted by Evaluator Quoc Huynh

COMPLAINT CONTROL NUMBER: 29-AS-20250723103455

FACILITY NAME:	ROYAL OAKS INN		FACILITY NUMBER:	567609831
ADMINISTRATOR:	JAKOBOVICH, BRANDON		FACILITY TYPE:	740
ADDRESS:	45 ERBES RD		TELEPHONE:	(805) 495-4657
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91362
CAPACITY:	80	CENSUS: 50	DATE:	08/22/2025
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Brandon Jakobovich - Administrator		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff did not address an outbreak of scabies in the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Quoc Huynh conducted an unannounced subsequent complaint visit to deliver findings for the above allegation. LPA arrived at 11:00AM and met with Administrator Brandon Jakobovich. Entrance interview conducted.

On 07/28/2025, the LPA interviewed three (3) Staff, three (3) Hospice Agency Staff, attempted one (1) resident interview, reviewed and obtained pertinent documents, and toured the physical plant.

During today’s visit, the LPA and Building Manager conducted a safety check tour at 11:30AM. No immediate concerns were observed. The following was then determined:

Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025

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-20250723103455

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ROYAL OAKS INN	FACILITY NUMBER: 567609831
	VISIT DATE: 08/22/2025

NARRATIVE

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Allegation: “Staff did not address an outbreak of scabies in the facility.”

It was reported that Resident #1 (R1) had scabies, and the facility did not address the matter. It was alleged that R1 had neighboring residents – Resident #2 (R2) and Resident #3 (R3) – who also had scabies and persistent rashes that resulted in R1 contracting scabies.

Record review revealed that R2 was admitted to the facility with persistent rashes that was actively treated by the facility and hospice. On 03/06/2025, R2 was prescribed Ivermectin for itching and on 06/16/2025 they were prescribed Permethrin and treated for scabies. Administrator Holly Gold stated that infection protocols were followed and R2’s condition subsided. Records confirmed R2 did not have any skin issues in July 2025. R3 was admitted to the facility with wound care addressed by hospice and prescribed Hydrocortisone with no documentation of rashes.

R1 was diagnosed with skin cancer and reported by Staff #1 (S1) and Staff #2 (S2) to have very fragile skin due to R1’s age and condition. S2 stated R1 had recurrent skin issues that were addressed and treated accordingly and due to autoimmune and inflammation episodes, had on and off again rashes. The Reporting Party (RP) initially reported scabies in November 2024 to which the facility staff denied the observation. However, the facility and hospice proceeded to treat R1’s rashes with scabies medication. They observed the medications and Aquaphor were not effective and switched to Triamcinolone ointment. The Triamcinolone was observed to work well and R1’s rashes improved. The RP was persistent with the alleged scabies outbreak to which they had R1 undergo a scrape test through UCLA Health on 03/04/2025 and the test returned negative. The RP reported that in April to May 2025, R1’s rash came back. Record review and interview with Hospice staff confirmed that during this time, R1 transferred hospice agencies and was no longer prescribed Triamcinolone. Once R1 was received the ointment again, the rashes improved.

Report Continued on LIC 9099-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20250723103455

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ROYAL OAKS INN	FACILITY NUMBER: 567609831
	VISIT DATE: 08/22/2025

NARRATIVE

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The RP stated they addressed the scabies to the facility several times and did not observe the facility make any changes. Between 06/23/2025 and 07/02/2025, S2 conducted staff in-service training and addressed topics including resident rights, bruises, skin breakdown, and infection control and personal protective equipment (PPE) protocols. On 07/14/2025, Purcor Pest Solutions visited and treated all areas of the facility. Between 04/24/2025 and 07/23/2025, Purcor Pest Solutions reported zero (0) pest activity. The LPA also observed PPE placed outside R1’s unit for contingency measures for the alleged outbreak.

Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed UNSUBSTANTIATED at this time.

No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025

LIC9099 (FAS) - (06/04)

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