Oakmont of Simi Valley

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Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Martha Arroyo conducted an unannounced Case Management - Incident visit. Upon arrival, the LPA met with the Executive Director (ED), Angela Avakian and explained the reason for the visit. Entrance interview. The reason for today's visit is to follow up on a self-reported incident report and Suspected Dependent Adult/ Elder Abuse (SOC 341) report received on 05/18/2026. The reports pertain to two (2) staff allegedly "inappropriately touching" Resident #1 (R1) while assisting with ADLs. During today’s visit, starting at 09:40 a.m., the LPA along with the ED conducted a physical plant tour and obtained copies of pertinent documents relevant to the investigation. Further investigation is needed, and an additional report may follow. No immediate health and safety concerns were observed during today's visit. No citations issued at this time. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, May 20, 2026

Type of visit: Case Management - Incident

The narrative section of the state’s online copy of this report is blank.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Brian Balisi and Martha Arroyo arrived at the facility unannounced to conduct a required annual visit at approx 9:45 a.m. Upon arrival, the LPAs were greeted by the front desk receptionist. Executive Director (ED) Angela Avakian, met with LPAs shortly after and LPAs explained the reason for the visit. At approx 10:00a.m. LPAs toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: LPAs inspected the kitchen/food service area. Knives and other sharp objects are stored and inaccessible to residents. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates and food labels had expiration date clearly marked. LPAs observed randomly selected resident bedrooms in memory care and assisted living. All resident bedrooms were furnished appropriately with linens, appropriate furnishings, and sufficient lighting. The LPAs observed a sufficient supply of towels and linens. All resident restrooms appeared clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. The water was measured between 105 - 120 degrees Fahrenheit. LPAs observed the emergency food supply, to be sufficient and properly stored in a storage room on the 2nd floor. LPA's observed furniture in the common areas were observed to be in good condition. The facility maintained a comfortable temperature. Activity Rooms were observed to be clean and well maintained at the time of visit. The LPAs observed required postings throughout the common space. The LPAs observed the stairwells and they each had an emergency evacuation chair. Outdoor areas were observed shaded with sufficient space to conduct activities with furniture suitable for outdoor use. LPAs observed passageways clear of obstruction. There were no bodies of water observed that posed any concern for residents in care. There are detached garages observed for resident's use. LPA observed one (1) garage to store additional furniture, equipment and other supplies for facility use. Records review, seven (7) client records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. seven (7) Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Daily vehicle inspection list and California Highway Patrol Inspection report was reviewed for facility vehicles. All files were observed to be in order at this time . Medication review, medications for randomly selected residents in Assisted Living and Memory care were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. Infection control / Emergency Disaster plan: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are conducted monthly; the facility’s next emergency disaster drill will be conducted in February. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s administrator. Facilities last fire and life safety inspection was conduction 12/09/2025. No vioaltions were notated at the time of inspection. Smoke detectors and carbon monoxide detectors were tested, all alarms were functional at the time of the visit. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster and Limited liability insurance. Exit interview conducted and copy of the report was issued.the state’s words, verbatim · CDSS document, Jan 26, 2026

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced case management visit to follow up on a recent incident report. Upon arrival, LPA met with Executive Director Angela Avakian and explained the reason for the visit. On 07/14/2025, the Regional Office received an incident report that stated, on 07/13/2025, the Executive director received a report of allegation of abuse. On 07/12/2025, Staff # 1 (S1) observed Staff #2 (S2) yell and slap Resident #1 (R1) on their back. R1 was assessed for signs or symptoms of physical or emotional distress, but R1 did not express any concerns. At approx 11:30 a.m. LPA conducted physical plant, interviewed five (5) staff, and reviewed and obtained copies of pertinent documentation relevant to the investigation. No immediate health and safety concerns were observed during the visit. No citations issued during the visit. LPA has determined further investigation is needed and will return at a later date to complete the investigation if warranted. Exit interview conducted, and copy of report issued.the state’s words, verbatim · CDSS document, Jul 18, 2025

Allegation investigated: Staff did not provide residents with adequate food services. Staff did not follow proper personal hygiene protocols. Staff did not provide adequate laundry services to residents. Staff did not maintain a comfortable temperature for resident(s).

Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent complaint visit to investigate the allegations listed above. During today’s visit, LPA met with Executive Director Christina Spears and explained the reason for the visit. On 03/14/2025, the initial complaint visit was conducted by LPA between approximately 12:30 p.m. - 02:30 p.m. During the visit, LPA’s conducted physical plant, interviewed staff, as well as, reviewed and obtained copies of pertinent documentation relevant to the investigation. Today LPA conducted interviews with staff and reviewed and obtained copies of additional pertinent documentation relevant to the investigation. It was reported that "Staff did not provide residents with adequate food services" as it was alleged that the food that has been served was inadequate at oftentimes served late.Interviews conducted with eight (8) staff members revealed all eight (8) reported that food has always been delivered to the memory care in a timely manner. Unsubstantiated Staff stated that meals typically include a variety of options such as scrambled eggs, soups, sandwiches, various proteins, salads, and other entrees requested by residents. None of the staff reported observing any food that appeared to be unappetizing or lacking in nutritional value. During the visit LPA observed that the main kitchen was adequately stocked with fresh fruits, as well as other perishable and non-perishable food items. All food was properly stored. In addition, interviews were conducted with three (3) family members or responsible parties of current residents. None of the individuals interviewed expressed any immediate or potential concerns regarding the quality of the food or the food service at this time. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation “Residents in care are not provided proper meal service” is deemed Unsubstantiated at this time. It was reported that "Staff did not follow proper personal hygiene protocols", as it was alleged that staff are not washing their hands, not wearing gloves and hair nets when serving food. Interviews were conducted with eight (8) staff members revealed all eight (8) reported that staff consistently follow proper hygiene protocols. None of the individuals interviewed could recall any instance where food was served to residents without proper hand hygiene being observed. Additionally, no concerns were raised by staff regarding any current issues with hand hygiene practices. During physical plant tours conducted on 03/14/2025 and 04/14/2025 during lunch service, the LPA observed that all staff were wearing appropriate attire while serving food to residents. Interviews were also conducted with three (3) family members or responsible parties of residents in care. None of the individuals interviewed reported any immediate or potential concerns related to staff hygiene practices at this time. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation “Staff did not follow proper personal hygiene protocols” is deemed Unsubstantiated at this time. It was reported that "Staff did not provide adequate laundry services to residents", as it was alleged that due to staff negligence, laundry is piled high in multiple locations and residents are often returned the wrong clothes. Interviews were conducted with eight (8) staff members revealed, six (6) out of the eight (8) reported that they have not observed a significant accumulation of laundry in resident rooms or in the laundry area. Two (2) staff members stated they had observed large amounts of laundry on a few occasions; however, they noted this had not occurred since the beginning of the year. These staff attributed the temporary buildup to instances where multiple residents had soiled their bedding overnight. All eight (8) staff members confirmed that, while residents’ clothing can occasionally be mixed up, such occurrences are rare. Staff reported being familiar with which clothing items belong to which residents, helping minimize such issues. A review of facility records showed that laundry is typically completed by the morning shift for residents scheduled to receive showers. The PM and NOC (night) shifts complete laundry for residents not served during the morning or according to the facility's established laundry schedule. During physical plant tours conducted on 03/14/2025 and 04/14/2025, the LPA did not observe any excessive or uncollected laundry on the memory care floor. Additionally, interviews with three (3) family members or responsible parties of residents in care revealed that none of them expressed any current or potential concerns regarding the adequacy of laundry services. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation “Staff did not provide adequate laundry services to residents” is deemed Unsubstantiated at this time. It was reported that "Staff did not maintain a comfortable temperature for residents" as it was alleged that staff oftentimes leave windows open in residents rooms at night. Interviews with eight (8) staff members indicated that none had observed any windows left open overnight or for an extended period without a resident’s request. Staff reported that, as part of their routine, both the PM and NOC (night) shifts conduct joint walk-through of resident rooms before residents go to sleep. During these checks, staff confirm that trash is not overflowing, windows are secured, and residents’ needs are being met. Interviews with three (3) family members or responsible parties of residents revealed that none expressed any immediate or potential concerns regarding staff maintaining a comfortable indoor temperature for residents at this time. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation “Staff did not maintain a comfortable temperature for residents” is deemed Unsubstantiated at this time. Exit interview conducted and copy of report issued.the state’s words, verbatim · CDSS document, Apr 14, 2025 · control 29-AS-20250312141224

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Brian Balisi and Martha Arroyo arrived at the facility unannounced to conduct a required annual visit at approx 9:45 a.m. Upon arrival, the LPAs were greeted by the front desk receptionist. The Executive Director (ED) Christina Spears, met with LPAs shortly after and LPAs explained the reason for the visit. The LPAs toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: The LPAs inspected the kitchen/food service area at 10:40 a.m. Knives and other sharp objects are stored and inaccessible to residents. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates and food labels had expiration date clearly marked. At approx. 10:50 a.m. ,the LPAs observed randomly selected resident bedrooms in memory care and assisted living. All resident bedrooms were furnished appropriately with linens, appropriate furnishings, and sufficient lighting. The LPAs observed a sufficient supply of towels and linens. All resident restrooms appeared clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. The water was measured between 105 - 120 degrees Fahrenheit. At approximately 11:00 a.m., the LPAs observed the emergency food supply, to be sufficient and properly stored in a storage room on the 2nd floor. LPA's observed furniture in the common areas were observed to be in good condition. The facility maintained a comfortable temperature. Activity Rooms were observed to be clean and well maintained at the time of visit. The fire extinguishers were fully charged and were last serviced 07/18/2024. The LPAs observed required postings throughout the common space. The LPAs observed the stairwells and they each had an emergency evacuation chair. Outdoor areas were observed shaded with sufficient space to conduct activities with furniture suitable for outdoor use. LPAs observed passageways clear of obstruction. There were no bodies of water observed that posed any concern for residents in care. There are detached garages observed for resident's use. LPA observed one (1) garage to store additional furniture, equipment and other supplies for facility use. At approx. 11:40 a.m. LPA’s reviewed Personnel Records and Resident Records. Six (6) personnel files and the current Executive Director’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. Six (6) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. The last fire alarm inspection was completed on 07/05/2024 and was found to be in compliance with Fire Code Regulations at the time of inspection. Fire Sprinkler system was last inspected 07/03/2024 and was found to be in compliance with Fire Sprinkler System Code Regulations. Fire and earthquake drills conducted within the last 6 months. Facility vehicle checklist's were reviewed during the visit. All records were observed to be in order at this time. Medications review began at approximately 12:30 p.m. The medications are centrally stored in med rooms in assisted living and Memory care. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. PRNs have physicians order on file. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during medications review. Infection control: Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. At this time, the staff will continue to keep up signs that promotes good hand hygiene. The facility has an adequate supply of Personal Protection Equipment (PPE), and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of an infectious disease. The facility’s policies and procedures as it pertains to infection control are adequate at this time. LPA's obtained the following documents at the time of visit: LIC500 Personnel Report, LIC9020 Client Roster, and a copy of the facility’s liability insurance. Interviews were conducted during the visit. Exit interview conducted. A copy of the report was provided to Executive Director.the state’s words, verbatim · CDSS document, Jan 16, 2025

Allegation investigated: Staff did not seek timely medical care for resident. Staff handled resident roughly causing a skin tear.

Licensing Program Analyst (LPA), Martha Arroyo conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above allegations. The initial visit was conducted on 04/16/2024, and a subsequent visit was conducted on 10/22/2024, by LPA M. Arroyo. On today's visit, LPA Arroyo met with Executive Director (ED), Christina Spears. Entrance interview. During the initial visit on 04/16/2024, LPA Arroyo toured the facility at 12:35 p.m., conducted interviews with the ED, four (4) staff, and four (4) randomly selected residents between 12:25 p.m. and 4:15 p.m., conducted a resident file review at 12:55 p.m., and obtained copies of pertinent documents. On 10/22/2024, LPA Arroyo conducted interviews with seven (7) residents between 1:25 p.m. and 2:40 p.m., conducted a resident file review at 12:45 p.m., and obtained copies of pertinent documents. Police Report was also obtained and reviewed. Report Continued on LIC 9099C... Unsubstantiated Report Continued from LIC 9099... It was alleged that staff did not seek timely medical care for resident. It was reported that Resident #1 (R1) is on blood thinners, and staff was unable to stop the bleeding on R1’s skin tear and although staff called 911 at 7:30 a.m., the incident occurred around 10:00 p.m. the previous night, and R1’s leg was bandaged by staff just prior to Emergency Medical Services (EMS) arriving at the facility. Interviews conducted with staff revealed that if a resident experiences a skin tear, it is immediately reported to the medication technician, who cleans and dresses the wound and try and figure out how the injury occurred. Additionally, if paramedics are needed, the medication technician is responsible for making the call. Staff interviews further revealed that R1's family was notified of the skin tear once staff became aware of it through R1's private companion. Staff stated that R1's family member requested that the facility staff address the skin tear and provide appropriate care. The following morning, staff noticed that the skin tear was still bleeding, prompting them to call R1's family again to provide an update. After several attempted calls, R1's family responded and agreed to have paramedics called to transport R1 to the hospital. Interviews with residents indicated that staff frequently communicate with family members when necessary, and residents confirmed that medical assistance has been sought when required. Additionally, residents did not report any concerns with the care provided by facility staff. Furthermore, staff promptly cleaned and dressed the skin tear as soon as they were made aware of it by R1's private companion, prior to the arrival of EMS at the facility. Based on the information obtained and reviewed, there is insufficient evidence to support the allegation of “staff did not seek timely medical care for resident”. Therefore, this allegation is deemed Unsubstantiated at this time. It was also alleged that staff handled resident roughly causing a skin tear. It was reported that while R1 was being assisted from their wheelchair to bed by two (2) staff members, when staff picked up R1, they threw R1 into bed like a “sack of potatoes” resulting in R1 sustaining a skin tear to the lower left leg. Interviews conducted with staff revealed that R1 was agitated and anxious for their personal companion to arrive. Due to R1's behavior, three staff members assisted in helping R1 to bed, with each staff member reporting that R1 was placed in bed for the night as they typically would on any other evening. Staff denied handling R1, or any other resident, roughly while assisting them at any time during their work at the facility. Report Continued on LIC 9099C... Report Continued from LIC 9099C... Further interviews with residents indicated that staff have always been kind and prompt when assisting them, and residents did not report any concerns regarding the care provided. Additionally, residents denied that facility staff were aggressive or handled them roughly, leading to bruises or cuts. Furthermore, according to a police report dated 04/11/2024, law enforcement conducted interviews and observations but was unable to establish that a crime had been committed against R1 by facility staff. Based on the information obtained throughout the investigation, there is insufficient evidence to support the allegation of “staff handled resident roughly causing a skin tear”. Therefore, this allegation is deemed Unsubstantiated at this time. Exit interview conducted. Report was reviewed and a copy was issued.the state’s words, verbatim · CDSS document, Nov 19, 2024 · control 29-AS-20240411103658

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Martha Arroyo and Brian Balisi arrived at the facility unannounced to conduct a required annual visit at 9:30 a.m. Upon arrival, the LPAs were greeted by the front desk receptionist. The Executive Director (ED) Remon Pagels, met with LPAs shortly after and LPAs explained the reason for the visit. The LPAs toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: At approx. 9:50 a.m. ,the LPAs observed three (3) random resident bedrooms in memory care and seven (7) random resident bedrooms in assisted living. All resident bedrooms were furnished appropriately with linens, appropriate furnishings, and sufficient lighting. The LPAs observed a sufficient supply of towels and linens. The LPAs observed ten (10) random resident restrooms during the inspection. All resident restrooms appeared clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. In memory care, the hot water temperature was measured at 124 degrees Fahrenheit in two (2) vacant rooms, a technical-violation was issued. Staff made adjustments during the visit and temperature was measured at 113 degrees Fahrenheit. In Assisted living, the hot water temperature was measured in seven (7) random assisted living bathrooms between 10:20 a.m. and 10:55 a.m., the temperature measured between 112.5 – 115 degrees Fahrenheit. At approximately 10:20 a.m., the LPAs observed the emergency food supply, to be sufficient and properly stored in a storage room on the 2nd floor. Continued on 809 Continued from 809 At the time of the visit, furniture in the common areas were observed to be in good condition. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguishers were fully charged and were last serviced 07/18/2023. The LPAs observed required postings throughout the common space. The LPAs observed the stairwells and they each had an emergency evacuation chair. Activity Rooms were observed and clean at the time of visit. The last fire inspection was completed on 06/28/2023 and was found to be in compliance with Fire Code Regulations at the time of inspection. Fire and earthquake drills conducted within the last 6 months as per regulation; the last one conducted 01/18/2024. The LPAs inspected the kitchen/food service area at 10:55 a.m. Knives are stored and inaccessible to residents. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates and food labels had expiration date clearly marked. At approx. 11am. LPA’s reviewed Personnel Records and Resident Records. Seven (7) personnel files and the current Executive Director’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. Seven (7) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All records were in order. Medications review began at approximately 01:00 p.m. The medications are centrally stored in the medication room on the second floor. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. PRNs have physicians order on file. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during medications review. Continued on 809-C Continued from 809-C LPAs conducted interviews with six (6) staff and five (5) residents during the inspection. Infection control: Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. At this time, the staff will continue to keep up signs that promotes good hand hygiene. The facility has an adequate supply of Personal Protection Equipment (PPE), and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of an infectious disease. The facility’s policies and procedures as it pertains to infection control are adequate at this time. Exit interview conducted and copy of report issued.the state’s words, verbatim · CDSS document, Jan 23, 2024