567609936-7-16-2021-29-AS-JROS-C4Z2JG-20210716172620

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 567609936
Report Date: 07/16/2021
Date Signed: 07/16/2021 05:26:40 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	OAKMONT OF RIVERPARK		FACILITY NUMBER:	567609936
ADMINISTRATOR:	GLEN MCCALL		FACILITY TYPE:	740
ADDRESS:	901 TOWN CENTER DRIVE		TELEPHONE:	(805) 940-0390
CITY:	OXNARD	STATE: CA	ZIP CODE:	93036
CAPACITY:	140	CENSUS: 81	DATE:	07/16/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	10:33 AM
MET WITH:	Glen McCall		TIME COMPLETED:	04:49 PM

NARRATIVE

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On 7/13/21 LPA spoke with staff Diana Flores regarding an incident report received for resident #1 (R1) indicating that R1 eloped from the facility on 7/11/21. Staff stated that R1 was wearing a wanderguard and had let the receptionist know that they were going to take their dog to go to the bathroom at the dog park located in the front of the building. Staff stated that when they had noticed that R1 had not returned from the dog park a med-tech and the driver went out to go look for R1. Staff stated that R1 was located approximately half a mile away from the facility without injury. Staff stated that they had made a list of residents who wear wanderguards and are not able to leave the facility without assistance. Staff stated that they are also working on in-servicing the staff.

During today’s visit LPA toured the facility with the Administrator and reviewed R1's records. Interview with Administrator starting at 11:38 am revealed that staff were given an in-service related to this incident and that staff Flores was the one that spoke with the receptionist regarding the incident. Administrator stated that they will obtain an updated physicians report to include R1's name and whether or not R1 can leave the facility unassisted. Administrator stated that R1's service plan will be updated to indicate R1's wandering. A review of R1's records starting at 11:40 am revealed that R1's physician's report does not indicate R1's name and whether or not R1 can leave the facility unassisted. R1's service plan dated 3/12/21 indicates R1 as oriented but occasionally forgetful. Sometimes confusion and/or difficulty in remembering simple details, may need prompting and orienting. R1's chart notes dated 12/26/2020 indicates R1 had been wandering outside the facility more consistently. 3/16/21 R1 left the facility unassisted and made it to the building across the street. 3/18/21 R1 wandered to the dog park at 9 pm and was very confused. Does not listen and continues to wander daily. Based on information obtained during the investigation staff failed to supervise R1 on 7/11/21 as R1 eloped from the facility.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D):

Exit interview conducted, todays reports were reviewed and emailed to the Administrator.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Joann Rosales	TELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 RIVERPARK	FACILITY NUMBER: 567609936
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/16/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/17/2021 Section Cited	1 2 3 4 5 6 7	87464 Basic services (f)(1)(c) "Care and supervision" means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. This requirement is not met as evidenced by:
	8 9 10 11 12 13 14	Based on interviews and record review, the licensee did not comply with the section cited above as R1 left the facility unassisted which poses an immediate health and safety risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Joann Rosales	TELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021

LIC809 (FAS) - (06/04)

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