567610033-2-29-2024-29-AS-DPEA-D3SSAX-20240328134301

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567610033
Report Date: 02/12/2024
Date Signed: 02/29/2024 01:57:05 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
11/15/2022 and conducted by Evaluator Teresa Camara

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20221115091459

FACILITY NAME:	OAKMONT OF SIMI VALLEY		FACILITY NUMBER:	567610033
ADMINISTRATOR:	MALEKSARKISSIANS, JINA		FACILITY TYPE:	740
ADDRESS:	3110 ROYAL AVE		TELEPHONE:	(805) 416-8600
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93065
CAPACITY:	0	CENSUS: 78	DATE:	02/12/2024
		UNANNOUNCED	TIME BEGAN:	12:55 PM
MET WITH:	Christina Spears		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Facility staff is not issuing the appropriate refund to resident's authorized representative
Facility staff failed to safeguard resident's personal belongings
Facility staff failed to meet resident's incontinence care needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint visit. LPA met with administrator/executive director (ED) Christina Spears and explained the reason for the visit.

During LPA's visit on 11/18/2022, LPA conducted interviews and obtained records. During LPA's visit on 2/12/2024 LPA conducted interviews with staff at 1:07 p.m., 3:07 p.m., and 3:20 p.m., and reviewed documents starting at 1:07 p.m.

On 2/29/2024, LPA conducted a subsequent visit to deliver an amended report as findings on one of the allegations in the original report was incorrect.

(continued on 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024

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-20221115091459

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: OAKMONT OF SIMI VALLEY	FACILITY NUMBER: 567610033
	VISIT DATE: 02/12/2024

NARRATIVE

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(continued from 9099)

Regarding the allegation the facility did not issue an appropriate refund after resident 1 (R1) moved out of the facility: LPA reviewed R1's admission agreement and the accounting for the refund. The refund sent to R1's representative was in compliance with regulations and the admission agreement. Therefore, this allegation is Unsubstantiated at this time.

Regarding the allegation R1's personal belongings were not safeguarded: R1 was missing a shirt. There was no indication in any notes that R1 was missing any personal items. Clothing and bedding are not commingled with other residents' belongings when they are laundered. R1 usually did not like to leave their room except for meals, so it was unlikely anyone wandered into R1's room to take anything. Since there was no documentation of missing items being reported to staff, this allegation is deemed Unsubstantiated at this time.

Regarding the allegations staff did not meet R1's incontinence care needs: LPA reviewed the facility's "Resident Care Notes" and staff frequently checked on R1. In addition, R1 would call out for staff assistance to use the restroom. There were staffing notes stating they were helping R1 sometimes every five to ten minutes. They stated R1 would use the bathroom and then call out to use the bathroom again just a few minutes later. The Health Services Director (HSD) had a discussion with R1's representative and it was agreed R1 would be on a schedule of every two hours for bathroom visits (or as needed) but R1 would still request assistance three times an hour. At the end of R1's stay at the facility, according to the Memory Care Director (MCD), R1 was on status checks every 30-60 minutes. Based on interviews and records reviewed, it appeared staff were checking on R1 frequently and R1 had the ability to call out for staff assistance when needed, therefore this allegation is deemed Unsubstantiated at this time.

No deficiencies were observed. Exit interview conducted and report issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024

LIC9099 (FAS) - (06/04)

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