567609936-9-8-2022-29-AS-KHEN-CJFSYM-20220920141746

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567609936
Report Date: 09/08/2022
Date Signed: 09/08/2022 06:42:34 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
08/26/2020 and conducted by Evaluator Kelly Dulek

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20200826163624

FACILITY NAME:	OAKMONT OF RIVERPARK		FACILITY NUMBER:	567609936
ADMINISTRATOR:	SULLIVAN, ROSALIE		FACILITY TYPE:	740
ADDRESS:	901 TOWN CENTER DRIVE		TELEPHONE:	(805) 940-0390
CITY:	OXNARD	STATE: CA	ZIP CODE:	93036
CAPACITY:	0	CENSUS: 0	DATE:	09/08/2022
		UNANNOUNCED	TIME BEGAN:	01:34 PM
MET WITH:	Chris Andersen		TIME COMPLETED:	05:48 PM

ALLEGATION(S):

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9

Facility staff did not shower resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint investigation for the allegation listed above. LPA arrived at the facility at 01:34PM and met with Executive Director (ED) Chris Andersen. Entrance interview conducted.

This report is being delivered to the current Executive Director, Chris Andersen, of Oakmont of Riverpark (LIC # 565850168) per prior approval of Susan McPherson, Senior Vice President of Regulatory Affairs for the management company.

During today's visit, LPA interviewed staff at 01:50PM, 02:52PM, 04:29PM, and 04:37PM, reviewed files at 02:03PM and obtained copies of pertinent documents, LPA toured the facility with Executive Director at 02:38PM, and conducted resident interviews from 03:11-03:33PM. Previously, on 09/03/2020, LPA Dulek

Report Continued on LIC 9099-C

Substantiated

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: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

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-20200826163624

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: 09/08/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/22/2022 Section Cited CCR 87464(f)(4)	1 2 3 4 5 6 7	87464 Basic Services (f) (4) Personal assistance and care as needed by the resident...with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Facility was closed effective 10/20/2021 due to a change of ownership.
	8 9 10 11 12 13 14	Based on interview and record review, the facility did not ensure R1 was showered as scheduled, which poses a potential health and personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	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: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

LIC9099 (FAS) - (06/04)

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