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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850168
Report Date: 03/20/2025
Date Signed: 03/20/2025 04:39:48 PM

Document Has Been Signed on 03/20/2025 04:39 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
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 RIVERPARKFACILITY NUMBER:
565850168
ADMINISTRATOR/
DIRECTOR:
KAILEY VANDERWALLFACILITY TYPE:
740
ADDRESS:901 TOWN CENTER DRIVETELEPHONE:
(805) 940-0390
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY: 140CENSUS: 92DATE:
03/20/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Kailey VanderwallTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced Case Management – Incident visit to the above facility. The LPA met with Executive Director Kailey Vanderwall and explained the reason for the visit. Entrance interview conducted.

The reason for today's inspection is to follow up on a self-reported death report received on 03/11/2025. The report pertains to the death of Resident #1 (R1). It was reported R1 was sent to the hospital on February 23th due to a fall and passed away on March 8th at the hospital.

During today's visit, the LPA conducted an interview with the Executive Director, Health Service Director, one (1) resident, conducted a brief tour of the facility and obtained copies of pertinent documents.

Further investigation is required prior to issuing findings.

Exit interview conducted. A copy of the report was issued to the Executive Director.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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