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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 567610033
Report Date: 07/16/2021
Date Signed: 07/16/2021 04:32:45 PM

Unsubstantiated


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
07/08/2021 and conducted by Evaluator Kasandra Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20210708103141
FACILITY NAME:OAKMONT OF SIMI VALLEYFACILITY NUMBER:
567610033
ADMINISTRATOR:MALEKSARKISSIANS, JINAFACILITY TYPE:
740
ADDRESS:3110 ROYAL AVETELEPHONE:
(805) 416-8600
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY:121CENSUS: 54DATE:
07/16/2021
UNANNOUNCEDTIME BEGAN:
10:11 AM
MET WITH:Jina MaleksarkissiansTIME COMPLETED:
12:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident is denied visitors without advance notice
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced initial complaint inspection at the facility today regarding the above allegation. At 10:18 AM the LPA met with Business Director Adena Sepani who had Administrator Jina Maleksarkissians on the telephone. The LPA explained the reason for today's inspection. At 11:04 AM the LPA met with the Administrator in person.

At 10:34 AM the LPA conducted a telephone interview with Staff #1 (S1). Beginning at 10:54 AM, the LPA reviewed facility records for Resident #1 (R1) and at 11:18 AM conducted an interview with R1. Interviews revealed R1 requested family members to call in advance prior to visiting R1. Based on the information obtained, the allegation of "Resident is denied visitors without advance notice" is deemed unsubstantiated at this time.

Report review and exit interview was conducted with Administrator Jina Maleksarkissians. Copy of the report and appeal rights will be emailed to the administrator.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
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.
LIC9099 (FAS) - (06/04)
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