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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 567609936
Report Date: 09/08/2022
Date Signed: 09/09/2022 12:01:07 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 RIVERPARKFACILITY NUMBER:
567609936
ADMINISTRATOR:SULLIVAN, ROSALIEFACILITY TYPE:
740
ADDRESS:901 TOWN CENTER DRIVETELEPHONE:
(805) 940-0390
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY:0CENSUS: 0DATE:
09/08/2022
UNANNOUNCEDTIME BEGAN:
01:34 PM
MET WITH:Chris AndersenTIME COMPLETED:
05:48 PM
ALLEGATION(S):
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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 03:11PM-03:33PM. Previously, on 09/03/2020, LPA Dulek

Report Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly DulekTELEPHONE: (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)
Page: 1 of 5
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
VISIT DATE: 09/08/2022
NARRATIVE
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conducted a telephone interview with the Administrator, Rosalie Sullivan, at 4:50PM and requested copies of pertinent documents for Resident #1 (R1). The following was then determined:

Interview revealed that R1 moved into the facility on a Tuesday and was scheduled for Tuesday/Thursday shower assistance. The resident did not take a shower at any of the 3 scheduled shower days for their first 2 weeks residing in the facility, as the shower record reflects R1 refused showers during those 3 scheduled shower services. Interviews revealed that a resident should be offered a shower three times during their scheduled date then if resident continues to refuse, the refusal reason is documented and if time allows, the resident is offered a shower the following day. Additionally, interview revealed that if a resident refuses showers for 2 scheduled days, the family should be contacted to notify of the refusal. In the case of R1, care notes reflect that R1's family member contacted the facility to inform the facility R1 had not been showered. Previous Administrator interview indicated this was not communicated to R1's family member timely. Therefore, based on interview and record review, the allegation that "Facility staff did not shower resident" is deemed SUBSTANTIATED at this time.

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 with Executive Director Chris Andersen. Today’s reports and appeal rights were reviewed and provided via email.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly DulekTELEPHONE: (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
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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 RIVERPARKFACILITY NUMBER:
567609936
ADMINISTRATOR:SULLIVAN, ROSALIEFACILITY TYPE:
740
ADDRESS:901 TOWN CENTER DRIVETELEPHONE:
(805) 940-0390
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY:0CENSUS: 0DATE:
09/08/2022
UNANNOUNCEDTIME BEGAN:
01:34 PM
MET WITH:Chris AndersenTIME COMPLETED:
05:48 PM
ALLEGATION(S):
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9
Medications are not given as prescribed
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kelly Dulek conducted an initial 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, conducted a medication audit at 02:52PM, and conducted resident interviews from 03:11-03:33PM.

Report Continued on LIC 9099-C

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly DulekTELEPHONE: (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)
Page: 4 of 5
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
VISIT DATE: 09/08/2022
NARRATIVE
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Previously, on 09/03/2020, LPA Dulek conducted a telephone interview with the Administrator, Rosalie Sullivan, at 4:50PM and requested copies of pertinent documents for Resident #1 (R1). The following was then determined:

R1's medications were reviewed based on documented MARs sent at the time of the initial complaint inspection. The allegation indicated R1 was not receiving their medication daily. However, regularly scheduled medications are documented on the MAR daily. R1 was receiving a PRN medication as requested, based on R1 requesting the medication as needed. Interview revealed R1 did not request the medication daily, nor had the physician ordered the medication scheduled regularly. Therefore, the medication was administered upon request on dates the resident requested the medication as needed, following the physician's orders. 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 "Medications are not given as prescribed" is deemed UNSUBSTANTIATED at this time.

Exit interview conducted with Executive Director Chris Andersen. A copy of the report was provided via email.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly DulekTELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5
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
09/08/2022
Section Cited
CCR
87464
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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:
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Facility was closed effective 10/20/2021 due to a change of ownership.
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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.
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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 HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly DulekTELEPHONE: (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)
Page: 3 of 5