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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850168
Report Date: 09/27/2024
Date Signed: 10/01/2024 08:16:25 AM

Substantiated


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
09/05/2023 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20230905101021
FACILITY NAME:OAKMONT OF RIVERPARKFACILITY NUMBER:
565850168
ADMINISTRATOR:CHRISTOPHER ANDERSENFACILITY TYPE:
740
ADDRESS:901 TOWN CENTER DRIVETELEPHONE:
(805) 940-0390
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY:140CENSUS: 88DATE:
09/27/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Kailey VanderwallTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff did not notify resident's responsible party of an incident
Staff did not communicate with resident's family regarding increase in medication
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Valeria Cownay conducted an unannounced subsequent complaint visit to the above facility. The purpose of the visit is to deliver final findings for a complaint initiated by LPA Z. Chochian on 09/13/2023. Upon arrival LPA met with Excecutive Director, Kailey Vanderwall, and the reason for the visit was explained.

On 09/05/2023, Community Care Licensing Division (CCLD) received a complaint with the above allegations. On 9/13/2023, LPA Z. Chochain conducted the initial visit. During the visit, between 12 p.m. – 3 p.m. LPA reviewed resident records, and interviewed staff and residents.

Continued on LIC 9099
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024
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 6
Control Number 29-AS-20230905101021
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 RIVERPARK
FACILITY NUMBER: 565850168
VISIT DATE: 09/27/2024
NARRATIVE
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Continued from LIC 9099-C

Following is a summary of the investigation findings:

Regarding allegation, “Staff did not notify resident’s responsible party of an incident” – it was alleged that Resident #1 (R1) sustained a fall at the facility on June 22, 2023, a week after admission and the responsible party was not informed. Staff interviewed revealed that R1 was admitted on 06/13/2023 and did sustain two (2) falls on or about 06/22/2023 and another in 08/23/2023. Staff interviews and records reviewed confirmed that the 06/22/2023 fall was not reported to the responsible person or the department. Based on the above information gathered, there is sufficient evidence to support the allegation of “Staff did not notify resident’s responsible party of an incident”. Therefore, the allegation is deemed SUBSTANTIATED at this time.

Regarding allegation, “Staff did not communicate with resident's family regarding increase in medication” – Information was received that facility staff requested a medication change from R1’s doctor without obtaining consent from R1’s responsible party. Records reviewed and interviews conducted with staff on 09/13/2023 revealed that between 6/24/2023-8/24/2023, R1’s was exhibiting behavioral issues which was reported to the doctor and therefore the seroquel medication was increased. Staff interviewed and records reviewed confirmed that R1’s seroquel medication was increased from 50mg to 75mg then to 100mg. Interview with staff revealed that R1’s change in condition since move-in and medication changes were not communicated to R1’s responsible person. Based on the above information gathered, there is sufficient evidence to support allegation “Staff did not communicate with resident's family regarding increase in medication”. Therefore, the allegation is deemed SUBSTANTIATED at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies was cited (refer to LIC 809-D):

Exit interview conducted. A copy of the report and appeal rights provided.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 29-AS-20230905101021
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 RIVERPARK
FACILITY NUMBER: 565850168
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
10/11/2024
Section Cited
CCR
87468.1(a)(8)
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Personal Rights of Residents(a) Residents in all residential care facilities for the elderly...following personal rights: (8) To have their representatives regularly informed by the licensee of activities related to care or services...This requirement is not met as evidenced by:
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Licensee agreed to inform responsible pary of any change of condition for all resident in care. Licensee will submit a statement of understanding of regulation cited by POC due date.
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Based on record review and interviews, licensee did not comply with the above section by failing to inform R1 Responsible party of any change in condition or care needs related to R1, which is a potential
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Deficiency Dismissed
Type B
10/11/2024
Section Cited
CCR
87211(a)(1)
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Reporting Requirements: (a) Each licensee shall... reports as the Department may require,...(1)A written report shall be submitted... person responsible...This requirement is not met as evidenced by:
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Licensee agreed to submit an incident report each time an event involving residents or staff occurs to CCL and responsible parties. Licensee will submit a statement of understanding of regulation cited by POC due date.
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Based on interviews and record review, licensee did not comply with the above section by failing to report incidents to the Department and the responsible party involving R1, which is a potential 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.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
09/05/2023 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20230905101021

FACILITY NAME:OAKMONT OF RIVERPARKFACILITY NUMBER:
565850168
ADMINISTRATOR:CHRISTOPHER ANDERSENFACILITY TYPE:
740
ADDRESS:901 TOWN CENTER DRIVETELEPHONE:
(805) 940-0390
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY:140CENSUS: 88DATE:
09/27/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Kailey VanderwallTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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9
Staff did not seek medical attention for a resident in a timely manner
Resident hygiene needs not met
Staff are taunting resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Valeria Conway, conducted an unannounced subsequent complaint visit to the above facility. The purpose of the visit is to deliver final findings for a complaint initiated by LPA Z. Chochian on 09/13/2023. Upon arrival LPA met with Excecutive Director, Kailey Vanderwall, and the reason for the visit was explained.

On 09/05/2023, Community Care Licensing Division (CCLD) received a complaint with the above allegations. On 9/13/2023, LPA Z. Chochain conducted the initial visit. During the visit, between 12 p.m. – 3 p.m. LPA reviewed resident records, and interviewed staff and residents.

Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024
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 6
Control Number 29-AS-20230905101021
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 RIVERPARK
FACILITY NUMBER: 565850168
VISIT DATE: 09/27/2024
NARRATIVE
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Continued from LIC 9099

Regarding allegation, “Staff did not seek medical attention for a resident in a timely manner” - The complainant alleged that Resident #1 (R1) was observed with a swollen arm and staff did not seek timely medical attention. Interview with staff and record reviewed confirmed that staff were notified that R1’s right arm was swollen by R1’s responsible person on 07/17/2024 and a tele-visit was conducted with R1’s doctor. Staff interviewed reported that prior to 7/17/2023, R1’s arm was not observed to be swollen. Following the tele-visit on 07/17/2023, R1’s doctor order an x-ray; which was conducted at the facility once the order was approved. X-ray of R1’s arm did not reveal any issue. R1 was a resident in the memory care unit and has since passed away. Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the above allegation “Staff did not seek medical attention for a resident in a timely manner” is deemed UNSUBSTANTIATED at this time.

Regarding allegation, “Resident hygiene needs not met” - It was alleged that R1 was not cleaned up after a bowl incident (date unknown) and was observed with dry feces on the hand the following day. Staff interviewed denied the allegation and expressed that if a resident is in the room resident is checked on at least every two hours by staff. Staff interviewed reported that residents are not left unattended and are checked on and cleaned regularly. Staff denied allegation and stated that resident are kept clean and odor free. Staff expressed that resident do have accidents and are cleaned immediately when observed. Facility common areas, and random resident rooms were toured in the assisted living and memory care on 9/13/2023, and 10/24/23. During these visits, residents and common areas did not observe to be unkept. R1 was a resident in the memory care unit and has since passed away. Based on the above gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the above allegation “Staff leaves residents unattended” is deemed UNSUBSTANTIATED at this time.

Continued on LIC 9099-C
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 29-AS-20230905101021
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 RIVERPARK
FACILITY NUMBER: 565850168
VISIT DATE: 09/27/2024
NARRATIVE
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Continued from LIC 9099-C

Regarding allegation, “Staff are taunting resident” - Information was received that during the firsts two weeks of move-in R1 was observed having a volatile episode and “nurses” (names unknown) observed laughing at R1. Random staff interviewed denied witnessing any “nurses” laughing at or taunting R1. No other witnesses to the alleged was reported. Interview was attempted with random resident in the memory care unit however residents were unable to effectively communicate with LPA due to loss of level of cognitive abilities. A few random residents who were greeted by LPA did express that they like the staff and are not mistreated. R1 was a resident in the memory care unit and has since passed away. Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the above allegation “Staff are taunting resident” is deemed UNSUBSTANTIATED at this time.

Exit interview conducted and copy of report provided.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6