567609936-11-29-2021-29-AS-KBUY-CV4K76-20230827073834

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567609936
Report Date: 11/29/2021
Date Signed: 11/29/2021 04:28:35 PM

Substantiated

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
05/18/2021 and conducted by Evaluator Joann Rosales

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20210518134750

FACILITY NAME:	OAKMONT OF RIVERPARK		FACILITY NUMBER:	567609936
ADMINISTRATOR:	LIBHART, JILL		FACILITY TYPE:	740
ADDRESS:	901 TOWN CENTER DRIVE		TELEPHONE:	(805) 940-0390
CITY:	OXNARD	STATE: CA	ZIP CODE:	93036
CAPACITY:	0	CENSUS: 87	DATE:	11/29/2021
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Kim Bergan		TIME COMPLETED:	04:27 PM

ALLEGATION(S):

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Staff are mismanaging residents' medication
Staff are not properly trained to assist residents with the self administration of medication.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) JoAnn Rosales conducted a subsequent complaint investigation visit at the facility. LPA met with Administrator Kim Bergan.

During today's complaint investigation LPA toured the facility with the Administrator, interviewed staff and reviewed staff records. Concerns were that staff are mismanaging resident medications. A review of resident medication records on 5/19/21 at approximately 4:15 pm revealed that resident #1 (R1) was prescribed zolpidem tartrate 10 mg tablet by mouth at bedtime. R1 was not given the medication on 4/5/21 and 4/22/21 as prescribed. Concerns were that staff are not properly trained to assist residents with the self administration of medication. Interviews on 11/29/21 starting at 1:50 pm with staff Jorge Moreno - Business Office Director and Diana Flores - Resident Care Coordinator revealed that staff #1 (S1) and S2 do not have documented medication training on file. Staff Flores stated that they were hired as a medication technician however, they do not have any documented
Continued on 9099C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Joann Rosales	TELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021

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-20210518134750

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 RIVERPARK	FACILITY NUMBER: 567609936
	VISIT DATE: 11/29/2021

NARRATIVE

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medication training on file. Based on the information obtained during the course of the investigation the allegations are deemed substantiated at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D):

Exit interview was conducted, today's reports and appeal rights 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: 11/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20210518134750

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 RIVERPARK	FACILITY NUMBER: 567609936
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/29/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/30/2021 Section Cited CCR 87465(a)(5)	1 2 3 4 5 6 7	87465 Incidental Medical and Dental Care Services (a)(5) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator stated that they will provide documentation of scheduled staff medication training to CCL by 11/30/21. Administrator stated that they will provide documentation of staff training to CCL by 12/10/21.
	8 9 10 11 12 13 14	Based on record review, the licensee did not comply with the section cited above in 1 out of 82 resident medications which poses an immediate health risk to persons in care.	8 9 10 11 12 13 14
Type B 12/01/2021 Section Cited HSC 1569.69	1 2 3 4 5 6 7	1569.69 Employees assisting residents with self-administration of medication; training requirements (a)(1) In facilities licensed to… This training shall consist of 16 hours of hands-on shadowing training, which shall be completed prior to assisting with the self- administration of medications, and 8 hours… This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator stated that staff Flores and S1 no longer assist residents with medications and S2 is currently on suspension and will most likely not be returning to the facility. Administrator stated that they will review and comply with the regulation and will submit a memo understanding to CCL by 12/1/21.
	8 9 10 11 12 13 14	Based on interviews, the licensee did not comply with the section cited above as staff Flores, S1 and S2 do not have documented medication training on file which poses a potential health risk to persons in care.	8 9 10 11 12 13 14

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: 11/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021

LIC9099 (FAS) - (06/04)

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