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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850168
Report Date: 01/16/2025
Date Signed: 03/10/2025 04:15:57 PM

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
02/06/2024 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20240206103814
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: 85DATE:
01/16/2025
UNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Kailey Vanderwall-EDTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Staff do not prevent resident from entering other residents' rooms
INVESTIGATION FINDINGS:
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Report was amended to reflect allegation was Substantiated. Amended Report emailed for signature. Signature on file.
Licensing Program Analyst (LPA), Esther Cortez conducted an unannounced subseqent complaint visit for the above allegation. Upon arrival, LPA met with the Executive Director (ED), Kailey Vanderwall , and was explained the reason for the visit. Entrance interview conducted.

On 02/12/2024, between 01:50 p.m. and 5:00 p.m., the LPA interviewed the ED, six (6) residents, conducted a file review, and obtained copies of resident records and other pertinent documents relevant to the investigation. On 01/14/2024, between 12:35 p.m. and 4:15 p.m., the LPA interviewed the ED, three (3) residents, five (5) staff, and obtained copies of resident records and other pertinent documents relevant to the investigation. During today's visit the LPA interviewed the current ED, Kailey Vanderwall and conducted a file review.
Report will continue on LIC9099-C, 2nd page.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
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 3
Control Number 29-AS-20240206103814
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: 01/16/2025
NARRATIVE
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On the allegation " Staff do not prevent resident from entering other residents' rooms"; it is the concern of the reporting party (RP) that Resident 1 (R1) goes into other resident’s rooms and roams the halls at night. It was further reported that R1 needs more care than what staff can provide. To investigate the allegations the LPA conducted a file review and interviews. A review of R1’s charting notes from 10/01/2023 to 02/14/2024 revealed that R1 had been wondering into resident’s rooms and wondering the halls during the day and at night very confused on different occasions. Additionally, on 10/04/2023, it was charted that R1 tried to take shirts from another resident and when the resident told them no, R1 bit them. On 12/24/2023, it was charted that at approximately at 8:37 p.m. it was reported that R1 could not be found, and R1 was found at 10:55 p.m. Majority of the residents interviewed revealed that R1 has entered their room uninvited, with one of the residents stating that they have voiced concerns to management and another resident stating that they feared R1. Staff interviews revealed that based on R1’s behaviors and needs they believed R1 required a higher level of care, such as being place in the Memory Care unit. Interview conducted with current ED, Kailey Vanderwall during today's visit revealed that R1 has been placed in memory care as of 04/24/2024. Based on interview and record review, the allegation that " Staff do not prevent resident from entering other residents' rooms " is deemed SUBSTANTIATED at this time.

Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited (refer to LIC9099-D).




Exit interview conducted. A copy of the report and appeal rights provided.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20240206103814
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: 01/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/24/2025
Section Cited
CCR
87464(f)(4)
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Observation of the Resident:The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs.
This requirement is not met as evidenced by:
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Current Executive Director reported that the facility residents are observed and monitored regularly and any significant change is reported accordingly. Will Submit a written self certification of understanding the regulation cited and their plan to ensure future compliance.
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Based on the investigation, the licensee did not comply with the section cited above as staff and file review revealed R1 was observed to be declining, and wondering into other residents rooms which posed a potential health and safety risk to residents in care.
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Will submit Statement by 1/24/25.
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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: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3