567609903-1-11-2023-29-AS-DPEA-CN8VAJ-20230119151601

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567609903
Report Date: 01/11/2023
Date Signed: 01/11/2023 01:09:17 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
09/11/2020 and conducted by Evaluator Kasandra Lopez

COMPLAINT CONTROL NUMBER: 29-AS-20200911111539

FACILITY NAME:	OAKMONT OF CAMARILLO		FACILITY NUMBER:	567609903
ADMINISTRATOR:	SUSAN RALPHS		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:	12:09 PM

ALLEGATION(S):

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Staff pulled resident's hair while in care
Staff laughed at resident while in care
Staff does not respond timely to pendent calls
Facility is insufficiently staffed

INVESTIGATION FINDINGS:

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

On 09/11/2020 Community Care Licensing Division (CCLD) received a complaint regarding the above allegations. On 09/11/2020, LPA Lopez conducted telephonic interviews with the complainant and witness/co-complainant. On 09/15/2020, the LPA conducted telephone interviews with two staff members between 10:42 AM and 12:02 PM.

On 09/18/2020, LPA Lopez initiated the investigation telephonically with Administrator Lea Bogoyevac due to the situation surrounding COVID-19 and to implement mitigation measures. At 11:29 AM the LPA conducted a virtual inspection via face time with Ms. Bogoyevac. Report continued on LIC 9099-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-20200911111539

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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During the inspection the LPA conducted an interview with Ms. Bogoyevac and requested pertinent records which was received on approximately 09/25/2020.

On 12/09/2021, the LPA conducted a Collateral inspection at the facility under the current license number 565850169 and met with Administrator at the time, Martha Berard. During the visit the LPA conducted interviews with three staff members (Staff #1, Staff #2, Staff #3) and reviewed records for Resident #1 (R1) and Staff #4 (S4). During the visit, the LPA was advised that R1 passed away and S4 no longer works at the facility.

On 04/22/2022, the LPA conducted a telephone interview with Staff #5 (S5) at 1:35 PM. On 01/04/2023 and 01/09/2023, LPA Lopez attempted to conduct a telephonic interview with S4 but was unsuccessful.

The allegations of ‘Facility is insufficiently staffed’ and ‘Staff does not respond timely to pendent calls’ alleges the facility is insufficiently staffed and did not respond to R1’s pendent calls timely. LPA requested pendent call records but they were unavailable. Interviews with staff revealed insufficient evidence to support there was insufficient staffing and staff did not respond timely to pendent calls. Therefore, the allegation is deemed unsubstantiated at this time.

The allegations of ‘Staff pulled resident’s hair while in care’ and ‘Staff laughed at resident while in care’ alleges S4 pulled R1’s hair accidentally while brushing their hair and laughed when R1 complained it hurt. The LPA attempted to interviewed S4 on two occasions and did not receive a returned call. Interviews with staff did not reveal sufficient evidence to support S4 acted inappropriately with residents. Therefore, the allegations of 'Staff pulled resident’s hair while in care' and 'Staff laughed at resident while in care' is deemed unsubstantiated at this time.

A copy of the report was emailed today 01/11/2023, to Susan McPherson for signature. A copy of the report was also emailed 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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