567609903-6-2-2021-29-AS-DPEA-CSCP58-20230531110017

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567609903
Report Date: 06/02/2021
Date Signed: 06/02/2021 04:21:58 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

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:	150	CENSUS: 76	DATE:	06/02/2021
		UNANNOUNCED	TIME BEGAN:	02:22 PM
MET WITH:	Lea Bogoyevac		TIME COMPLETED:	04:25 PM

ALLEGATION(S):

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Facility does not post complaint information in areas accessible to residents, representatives and the public.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced initial complaint inspection at the facility today. The LPA arrived at 2:22PM and met with Administrator Lea Bogoyevac. The LPA informed the Administrator of the reason for today's inspection.

During today's visit, LPA Dulek conducted a facility tour with Administrator Lea 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:

During the facility tour, the following postings were observed in the lobby: a copy of the facility license as well as information indicating "copies of licensing reports are available upon request at the Concierge Desk." LPA observed the Long Term Care Ombudsman poster in the facility's Activity Room as well as in the hallway 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: 06/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2021

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: 06/02/2021

NARRATIVE

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outside the elevator on the second floor. Also observed in the Activity Room is the CDSS complaint poster (PUB 475), Personal Rights of Residents in Privately Operated Residential Care Facilities for the Elderly, as well as the "Rights of Resident Councils" and accompanying information, anti-discrimination notice, visiting policies, and resident right to voice complaints, grievances and suggestions. Outside the lobby, next to the resident mailboxes, there is a posting indicating personal property procedures for RCFE. All required postings were visible during the facility tour. Therefore, there is not enough evidence to support the allegation and the allegation that "Facility does not post complaint information in areas accessible to residents, representatives and the public" is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. A copy of the report and appeal rights were provided via email.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2021

LIC9099 (FAS) - (06/04)

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