567609903-5-23-2023-29-AS-DPEA-CSCPNJ-20230531112802

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567609903
Report Date: 05/23/2023
Date Signed: 05/23/2023 05:37:11 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
06/30/2021 and conducted by Evaluator Kelly Dulek

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20210630154615

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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Due to lack of care and supervision, resident sustained pressure wound while in care
Facility did not let external services provide care for resident

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 allegations. The LPA arrived at 12:40PM and met with Business Office Director Kailey Vanderwall. The LPA informed the Business Office Director and Executive Director (ED) 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 a previous visit on 07/01/2021, LPAs Martha Guzman Chavez and Kelly Dulek conducted an interview with Regional Executive Director Specialist at 12:25PM, toured the facility at 12:34PM, conducted staff

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-20210630154615

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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interviews at 1:40PM and 2:35PM, resident interview at 2:46PM, reviewed medications at 1:40PM, toured Memory Care with Memory Care Director at 2:35PM and gathered copies of documents pertinent to the investigation. Throughout the course of the investigation, LPA reviewed pertinent documents and interviewed additional staff. The following was then determined:

It was alleged that due to lack of care and supervision, Resident #1 (R1) sustained a pressure wound while in care. Interview revealed that prior to R1 moving into the facility, R1 had been residing temporarily at a Skilled Nursing Facility (SNF) for recovery from a previous injury. R1 moved into the facility on 03/11/2020. Record review revealed that R1's physician wrote an order on 04/02/2020 for "hospice referral for patient," "heel ulcer needs wound care," and written at the bottom included "referral to SNF for stage III pressure ulcer." R1 was then admitted to hospice effective 04/21/2020. Interview with staff revealed that if a resident is noted with any skin irritation/redness or any open wounds, the resident's physician is notified via fax and staff will monitor the resident closely and document all observations. Interview also revealed that any residents who are bedridden are rotated every 2 hours to help with skin integrity. While R1 did have a documented pressure wound, it is unclear whether the resident had that wound when R1 moved into the facility. Further, it is unclear whether the resident sustained the pressure injury due to lack of care and supervision. Additionally, as R1 was admitted to hospice around the time of the pressure injury due to declining overall condition as a result of end stage Dementia, it is unclear whether the pressure injury can be attributed to the overall decline. As a result, 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 "due to lack of care and supervision, resident sustained a pressure wound while in care is deemed UNSUBSTANTIATED at this time.

It was also alleged that the facility did not allow wound care treatment on 04/12/2021 due to COVID. Hospice sign in record revealed that Hospice nurse had visited R1 on 04/08/2021 and did not visit again until 04/29/2021. Record review revealed that there was an unrelated positive COVID resident reported to CCL on 04/16/2021. This resident was reported as symptomatic and hospitalized on 04/14/2021. The resident subsequently tested positive at the hospital and remained out of the facility for the duration of their isolation period. No additional residents tested positive at that time. Interview revealed that at all times home health and hospice services continued throughout COVID, as hospice and home health were viewed as essential.
Report Continued on LIC 9099-C

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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Control Number 29-AS-20210630154615

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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R1's family member visited on 04/21/2021, indicating the facility was open and receiving visitors at that time and visitation was not restricted. Hospice note dated 04/08/2021 indicated "routine revisit...for recertification for Hospice Services.." It is unclear of the date recertification was completed and if there was a lapse in hospice certification coverage at the time of the complaint allegation. 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 "Facility did not let external services provide care for resident" is deemed UNSUBSTANTIATED at this time.

Exit interview conducted with ED 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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