567609903-1-11-2023-29-AS-DPEA-CN9T33-20230120132138

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567609903
Report Date: 01/11/2023
Date Signed: 01/11/2023 01:36:34 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
02/23/2021 and conducted by Evaluator Kasandra Lopez

COMPLAINT CONTROL NUMBER: 29-AS-20210223144138

FACILITY NAME:	OAKMONT OF CAMARILLO		FACILITY NUMBER:	567609903
ADMINISTRATOR:	LEATRICE BOGOYEVAC		FACILITY TYPE:	740
ADDRESS:	305 DAVENPORT STREET		TELEPHONE:	(805) 738-3600
CITY:	CAMARILLO	STATE: CA	ZIP CODE:	93012
CAPACITY:	0	CENSUS: 0	DATE:	01/11/2023
		UNANNOUNCED	TIME BEGAN:	11:13 AM
MET WITH:	Susan McPherson		TIME COMPLETED:	11:47 AM

ALLEGATION(S):

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Staff failed to follow physician's orders when assisting the resident with medications.
Staff failed to assist the resident with the self-administration of medication.
Resident's meal was not delivered timely.
Staff failed to assist Resident's care needs timely.

INVESTIGATION FINDINGS:

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Licensing Program Analyst KaSandra Lopez conducted a telephonic interview at 11:13 AM with Susan McPherson, Senior Vice President of Regulatory Affairs for Oakmont Management Group to deliver findings regarding the above allegations. Ms. McPherson was informed of the complaint findings. The facility closed effective 10/21/2021 and the property was re-licensed under a new licensee.

On 02/23/2021 Community Care Licensing Division (CCLD) received a complaint regarding the above allegations. On 03/04/2021 at 3:24 PM, LPA Lopez due to the situation surrounding COVID-19 and to implement mitigation measures, initiated a complaint tele-investigation with Administrator Leatrice Bogoyevac. Health and Services Director Susan Ralphs was added to the telephone call at 3:30 PM and was also interviewed.

Report continued on LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023

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-20210223144138

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: 567609903
	VISIT DATE: 01/11/2023

NARRATIVE

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At 3:38 PM, the LPA conducted a face time interview with Resident #1 (R1) and Individual #1 (I1), whom is a family member of R1. During the visit, the LPA also requested facility records for R1, including medical records, medication records, needs and service plan, and staff schedule which were received on approximately 03/19/2021.

On 12/09/2021, a subsequent inspection was conducted at the facility location under the current license number 565850169 and met with current Administrator at the time, Martha Berard. The LPA reviewed records for R1 and conducted an interview with Staff #1 (S1). On 01/09/2023 and 01/11/2023, LPA Lopez attempted to conduct a telephone interview with Staff #2 (S2) but was unsuccessful.

The allegation of ‘Staff failed to follow physician’s orders when assisting the resident with medications’ alleges when staff gave R1 their medication, R1 was allowed to "choose" which medications R1 wanted to take. Interviews and medication record review revealed R1 refuses to take their medication often and would refuse all their medications not just certain medication. The medication records for the month of February 2021 revealed R1 refused all their medications approximately seven times. During the interview with I1, I1 stated they visit R1 often and never observed staff ask R1 which medication they wanted to take. LPA attempted to interview the med-tech who was working during the time, the complainant stated the incident occurred but was unable to obtain an interview. Based on the information obtained, there is insufficient evidence to support the allegation ‘Staff failed to follow physician’s orders when assisting the resident with medications. Therefore, the allegation is unsubstantiated.

The allegation of ‘Staff failed to assist the resident with the self-administration of medication’ alleges staff attempted to leave medications with R1’s private caregiver to give to R1. Interviews with I1 revealed facility staff always stay with R1 when giving R1 their medications. LPA attempted to interview the med-tech who was working when the private caregiver was working but was unable to obtain an interview. Based on the information obtained, there is insufficient evidence to support the allegation of ‘Staff failed to assist the resident with the self-administration of medication’. Therefore, the allegation is unsubstantiated.

Report continued on LIC 9099-C.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20210223144138

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: 567609903
	VISIT DATE: 01/11/2023

NARRATIVE

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The allegation of ‘Resident's meal was not delivered timely’ alleges R1’s food is supposed to be delivered at a certain time but was delivered late. Interviews with R1 and I1 revealed they were happy with the care and service R1 receives and had no complaints at this time. The interview with Susan Ralphs revealed R1 did not have an order for their meals to be delivered at a certain but they are delivered to R1’s room by their choice during the mealtime hours. Based on the information obtained, there is insufficient evidence to support the allegation of Resident’s meal was not delivered timely’. Therefore, the allegation is deemed unsubstantiated at this time.

The allegation of ‘Staff failed to assist Resident's care needs timely’ alleges R1 had to wait 40 minutes for a staff to respond to R1 needing assistance. The interview with I1 revealed they visit R1 often and pendent response times are usually between 5-10 minutes. Interviews with staff revealed similar response times. Based on the information obtained, there is insufficient evidence to support the allegation of ‘Staff failed to assist Resident's care needs timely’. Therefore, the allegation is deemed unsubstantiated.

A copy of the report was emailed to Susan McPherson for signature and mailed to the Licensee’s mailing address.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023

LIC9099 (FAS) - (06/04)

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