567609903-5-23-2023-29-AS-DPEA-CSCP57-20230531110015

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567609903
Report Date: 05/23/2023
Date Signed: 05/23/2023 05:35:40 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
05/24/2021 and conducted by Evaluator Kelly Dulek

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20210524124642

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:	05/23/2023
		UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Bradlee Foerschner		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Resident is developing rashes while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced subsequent complaint inspection at the facility today, with the purpose of delivering findings for the above listed allegation. The LPA arrived at 12:40PM and met with Business Office Director Kailey Vanderwall. The LPA informed the Business Office Director and Executive Director of the reason for today's inspection. Entrance interview conducted.

This report is being delivered to the current Executive Director, Bradlee Foerschner, of Oakmont of Camarillo (LIC # 565850169) per prior approval of Susan McPherson, Senior Vice President of Regulatory Affairs for the management company.

During today's visit, Licensing Program Analyst (LPA) Kelly Dulek interviewed staff at 12:49PM and 01:22PM, reviewed Resident #1 (R1)'s file at 02:11PM and received copies of pertinent documents. During an initial complaint visit on 06/02/2021, LPA Dulek conducted a facility tour with then-Administrator Lea
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: 05/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

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-20210524124642

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: 05/23/2023

NARRATIVE

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Bogoyevac and Health Services Director Susan Ralphs at 2:52PM, an interview with the Administrator at 2:23PM, interviewed staff at 2:35PM and 3:00PM and gathered copies of documents pertinent to the investigation. The following was then determined:

It was alleged that R1 developed rashes while in care. Record review revealed that R1's care needs changed and an updated assessment was completed on 05/10/2021. Prior assessment indicated that R1 was "occasionally incontinent of bladder or bowel and can self manage." However, assessment completed on 05/10/2021 indicates R1 "requires schedule for toileting and assistance to and from restroom." R1's physician signed orders for barrier cream to be used as needed for rash and R1's physician indicated that R1 "can determine and communicate his/her need for prescription and non-prescription PRN medications." Therefore, the physician's orders indicate R1 is capable of determining their own need for use of the barrier cream to treat rashes. Record review indicates R1's physician was made aware of rashes via fax on the following dates: 11/03/2020, 03/06/2021, and 05/27/2021. Each time, R1's physician replied and indicated new care instructions for applying creams to R1 to treat the rash. No additional care notes were found to reflect additional rashes observed on R1. Prior to the 05/10/2021 change in condition care plan, R1 was able to care for their own toileting needs and determine their own need for PRN medication barrier cream. After 05/10/2021, there was only one rash noted on 05/27/2021 and R1's physician replied the same day with new orders for an additional cream to be used to treat the rash. Interviews revealed that incontinence care is provided to residents with that need identified in their needs and service assessment to require that level of care every 2 hours. Any rashes or redness noted to a resident is documented in their care notes and the medication technician sends a fax to the resident's doctor to obtain instructions on how to care for the resident's needs. In the case of R1, the facility staff appear to have followed the protocol for physician communication and received orders promptly. Based on interview and record review, although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegation that "resident developed rashes while in care" is deemed UNSUBSTANTIATED at this time.

Exit interview conducted with ED Bradlee Foerschner. A copy of the report was provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

LIC9099 (FAS) - (06/04)

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