Oakmont of Fullerton.

On January 30, 2026, 8:40 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Executive Director (ED) Maria Kauten and explained the purpose of the visit. The facility is licensed to operate for one hundred fifty-two (152) nonambulatory residents of which eight (8) may be bedridden and have a hospice waiver for fifteen (15) residents. The facility is a three-story structure and consists of the following: one hundred and one (101) resident bedrooms, nine (9) offices, one hundred and ten (110) bathrooms, living area, two dining areas, bar and lounge, TV room, kitchen, bistro, great area, theater room, fitness center, massage room, general outdoor patio area, outdoor dining courtyard, dog park, and a memory care outdoor patio area. LPA Kim toured inside and outside of the physical plant with ED Kauten. There were no obstructions on the premises. There are two small fountains in the general outdoor courtyard and a small fountain in the Memory Care Courtyard. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, a chair, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The following Resident’s rooms were inspected: Resident Room 104, Resident Room 112, Resident Room 114, Resident Room 123, Resident Room 129, Resident Room 212, Resident Room 224, Resident Room 230, Resident Room 312, Resident Room 320, and Resident Room 331. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 111.1 degrees F to 115.7 degrees F. A comfortable temperature of 74 degrees F was maintained in the facility. Evaluation Report Continues on LIC 809-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food, emergency water, and emergency supplies were stored in the kitchen and staff emergency work room. The facility has twenty-one (21) fire extinguishers that were charged, mounted throughout the facility, and serviced on October 9,2025. During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The smoke detectors and carbon monoxide detectors were inspected by Calbuilding Systems on October 9, 2025. A working telephone (714-869-1940) and an internet capable devices for video teleconferencing purposes remains available. LPA observed the facility Evidence of Liability Insurance was effective 08/06/2025, and expires on 08/06/2026. Emergency Drills were conducted quarterly and last conducted on January 21, 2026. LPA Kim conducted an audit of twelve (12) resident files (R1-R12), nine (9) staff files (S1-S9), and medication and medication administration record were all in order and complete. LPA Kim conducted five (5) staff interviews and eight (8) resident interviews. No deficiencies were cited during this visit. An exit interview was conducted, and a copy of this report was provided to Executive Director Maria Kauten.

Based on interviews conducted, four out of seven residents and eight out of eight staff denied the allegation staff spoke inappropriately to resident in care. Three out of seven residents could not confirm or deny the allegation. One witness confirmed the allegation. All staff, R4, R5, R6, and R7 stated they have never heard or observed S1 speaking inappropriately to any residents. All staff stated they would report to the Executive Director or other agencies if they observed any staff say any obscene or inappropriate language. Based on observations on November 13, 2025, LPA did not observe any staff speak inappropriately to memory care residents. On January 30, 2026, LPA did not observe any staff speaking inappropriately to memory care residents. Based on record reviews, there are no records of S1 in regards to complaints, disciplinary actions, and facility charting notes stating S1 spoke inappropriately with R1. Based on Facility Charting Notes for R1 dated from September 22, 2025, to December 28, 2025, there are no notes stating that S1 spoke inappropriately or any complaints from R1 about S1 or any staff. Based on observations, interviews, and records review, LPA did not find sufficient evidence to support the above allegation that facility staff verbally abused a resident. 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 allegation is Unsubstantiated. Exit interview was conducted, and a copy of the report was provided to Executive Director Maria Kauten.

Based on interviews conducted, four out of seven residents and eight out of eight staff denied the allegation. Two out of three residents interviewed could not confirm or deny the allegation. All staff, R4, R5, R6, and R7 stated they have not observed or heard any residents being handled in a rough manner. R4, R5, R6, and R7 stated they have not been handled in a rough manner by S1 and S2 during their shower time. Based on record reviews, there are no records of any disciplinary actions or complaints from the facility for S1 and S2. There are no incident reports related to R1 with S1 and S2 handling their shower time. Charting Notes for R1 dated from October 9, 2025 to November 29, 2025, do not note any injuries with a result from staff scrubbing too hard during shower times. Based on observations, LPA Kim did not observe any screaming residents during their time at the facility because they were handled in a rough manner. Allegation: Staff did not provide clean linens to residents in care. It is alleged that the staff in the memory care unit do not change the soiled linens in a resident’s room. Based on record review, LPA observed the cleaning schedule for the facility. Resident rooms are cleaned by the housekeepers once a week based on their designated areas. Based on observations, LPA inspected and visited the following rooms: 102, 104, 109, 112, 119, 125, 129, 209, 218, and 307. LPA observed these rooms to have clean linens during the inspection. Based on interviews conducted, four out of seven residents and eight out of eight staff denied the allegation. Three out of seven residents could not confirm or deny the allegation. All staff, R4, R5, R6, and R7 stated they have clean linens and if they get soiled linens the staff provides new linens and clean the soiled linens the same day. Staff stated they would take the soiled clothes and linens, then proceed to place it in the bag with the resident’s name and room number. Anything they need to put in the trash, they would take out immediately. All staff stated they would check the resident’s room at least once a day, at the end of their shift, to see if there was any need to clean up anything in the room. Allegation: Staff did not clean resident rooms. It is alleged that the staff in the memory care unit do not take out the trash. Continued on LIC9099C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Based on record review, LPA observed the cleaning schedule for the facility. Resident rooms are cleaned by the housekeepers once a week based on their designated areas. Based on observations, LPA inspected and visited the following rooms: 102, 104, 109, 112, 119, 125, 129, 209, 218, and 307. LPA observed these rooms to be clean with no trash or litter throughout the bedroom. When a common area bathroom was a mess after a person who reported it, LPA observed staff immediately call in the housekeeping staff to clean the common bathroom. Housekeeping came within 2 minutes to go and clean up the common area bathroom. Based on interviews conducted, four out of seven residents and eight out of eight staff denied the allegation. Three out of seven residents could not confirm or deny the allegation. All staff, R3, R4, R5, R6, and R7 stated that the facility regularly cleans the bedrooms. All residents stated that the staff come in multiple times throughout the day to clean up trash. The caregivers stated it was their responsibility to make sure at least by the end of the shift they take out the trash and make sure the room was clean before they left. Based on the information gathered, there is no sufficient evidence to confirm the above allegation. Based on observations, interviews, and records review, LPA did not find sufficient evidence to support the above allegations that staff handled resident in care in a rough manner, staff did not provide clean linens to residents in care, and staff did not clean resident rooms. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. Exit interview was conducted a copy of the report was provided to Executive Director Maria Kauten.

Allegation: Resident was severely dehydrated due to neglect- Unsubstantiated Facility staff, including two (2) Licensed Vocation Nurses (LVN’s) who cared for Resident #1 (R1) all stated R1 was provided juice, milk and water with each meal. In addition, R1’s family provided them with a small refrigerator in their room that was stocked with water. There are also beverages offered in the dining room, bar and Bistro area all day and R1 was ambulatory and had access to these areas. Staff indicated that R1 could express their needs and would ask staff when they needed something. None of the staff ever observed any signs or symptoms of R1 being dehydrated. Medical Records for R1’s visit on 03/11/2023 states they were treated with IV fluids due to signs of clinical dehydration. However, it does not provide any other information. R1 had a second visit on 03/12/2023 and there was no documentation of dehydration. Allegation: Resident was severely malnutrition due to neglect- Unsubstantiated Facility staff, including two LVN’s who cared for R1 all stated R1 ate well. However, R1 would occasionally say they were full and not finish their meal because they did not like what was being served. None of the staff who cared for R1 observed any signs of R1 being malnourished. In addition, R1 was able to communicate their needs and ask staff for what they need. In February of 2023, staff voice concerns of R1 losing weight which was brought to the attention of R1s physician who prescribed R1 medication to enhance their appetite. R1 was sent back to the hospital on 03/12/2023, due to low blood pressure reading again. R1 was diagnosed with severe protein calorie malnutrition. However, there is a notation that states this condition was first noted on 03/18/2023, six days after R1’s admission to the hospital, and it is unknown if condition was present at admission on 03/12/2023. **Report continued on 9099-C** 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Allegation: Resident not changed timely- Unsubstantiated Interviews with staff indicated that caregivers are assigned residents at the beginning of their shift, which means they are to assist with those residents with incontinence care needs. Staff interviews further revealed that residents are assisted with incontinence care every two hours or as needed. Residents will also utilize their pendant if they need assistance between that time. Resident interviews revealed that staff meet their incontinence needs. Residents indicated they feel comfortable with staff and will use their pendants or staff will just check on them. Allegation: Due to neglect, Resident received a fracture while in care- Unsubstantiated According to facility staff, R1 had unwitnessed fall while at the facility. The first one in November 2022 and the second one in January 2023. R1 was evaluated by facility LVN on both occasions. R1 had no visible injuries, complaints of pain and when they were helped to their feet, they were able to walk without any complaints or signs of pain. Staff indicated that R1 was walking without assistances or signs of pain up until the day they were first transported the hospital on 03/11/2023. During R1’s visit to the hospital on 03/11/2023, record review indicated R1 had a Severe T8 Compression Fracture. Records reviewed did not contain any further details or how the fracture may have occurred or was treated. R1 had a follow up visit at the hospital on 04/04/2023. R1 was diagnosed with “Chronic appearing T8 Compression Fracture” Interview with medical professional revealed it is common for someone R1s age to suffer compression fractures and there is no way for them to determine the age of the injury or when it may have occurred. Based on interviews conducted and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED . A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted. A copy of this report was provided and appeal rights provided.

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of following up on the investigation of one complaint filed regarding the previous licensed entity at this present location, prior to the initial licensing of the present facility. Complaint is referenced as follows: 22-AS-20210818113839, filed on August 18, 2021. The complaint was filed in regard to licensed facility Oakmont of Fullerton - 306005795 which is a distinct entity from the present facility. During the investigation, LPA attempted to conduct an additional interview with a facility resident, who declined to be interviewed. An exit interview was conducted and a copy of this report was provided to a facility representative.

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of following up on the investigation of four complaints filed regarding the previous licensed entity at this present location, prior to the initial licensing of the present facility. Complaints are referenced as follows: - 22-AS-20210818113839, filed on August 18, 2021 - 22-AS-20210917092143, filed on September 17, 2021 - 22-AS-20220822143206, filed on August 22, 2022 - 22-AS-20220906140344, filed on September 6, 2022. All four complaints have been filed against licensed facility Oakmont of Fullerton - 306005795 which is a distinct entity from the present facility. During the investigation, LPA requested multiple resident records and conducted or attempted to conduct staff and resident interviews. An exit interview was conducted and a copy of this report was provided to a facility representative.

On December 18, 2024, at 4:30pm, Licensing Program Analyst (LPA) Edward Kim conducted a Case Management visit following up an email self-reporting an incident that occurred at the facility. LPA Kim was greeted and granted entry by Concierge Lexine Toya. LPA Kim met with Executive Director (ED) Maria Kauten and explained the purpose of the visit. During today’s inspection, LPA Kim conducted health and safety check and conducted interviews with ED Kauten, Business Office Director Laura Britain, and Kitchen staff. LPA observed the dishwasher in the kitchen where the incident occurred. The fire department provided a report number F2415915. The cause of the fire was the dishwasher's electric motor melted and burned inside of the dishwasher unit. The fire has been contained and no staff and residents were hurt. No staff or residents were sent to the hospital. Based on observations and interviews, there are no health and safety concerns at the facility. A copy of the fire report, Personnel Report, Resident Roster, and other pertinent documents were provided to the LPA. An exit interview was conducted and a copy of this report was given to Executive Director Maria Kauten.

On November 5, 2024, at 8:45am, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and granted entry by Concierge Jessica Ramirez. Executive Director (ED) Maria Kauten arrived the facility around 11:00am. The facility is licensed to operate for one hundred fifty-two (152) nonambulatory residents of which eight (8) may be bedridden and have a hospice waiver for fifteen (15) residents. The facility is a three story structure and consists of the following: one hundred and one (101) resident bedrooms, nine (9) offices, one hundred and ten (110) bathrooms, living area, two dining areas, bar and lounge, TV room, kitchen, bistro, great area, theater room, fitness center, massage room, general outdoor patio area, outdoor dining courtyard, dog park, and a memory care outdoor patio area. LPA Kim toured inside and outside of the physical plant with Business Office Director Laura Britain and Health Service Director Jhoana Salmi. There were no obstructions on the premises. There are two small fountains in the general outdoor courtyard and a small fountain in the Memory Care Courtyard. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, a chair, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The following Resident’s rooms were inspected: Resident Room 105, Resident Room 115, Resident Room 119, Resident Room 212, Resident Room 225, Resident Room 229, Resident Room 231, Resident Room 307, Resident Room 315, and Resident Room 323. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 110.3 degrees F to 113.9 degrees F. A comfortable temperature of 72 degrees F was maintained in the facility. Evaluation Report Continues on LIC 809-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food, emergency water, and emergency supplies were stored in the kitchen and staff emergency work room. The facility has twenty-one (21) fire extinguishers that were charged, mounted throughout the facility, and serviced on November 5, 2024. During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The smoke detectors and carbon monoxide detectors were inspected by Calbuilding Systems on October 17, 2024. A working telephone (714-869-1940) and an internet capable devices for teleconferencing purposes remains available. LPA observed the facility Evidence of Liability Insurance was effective 12/31/2023 and expires on 12/31/2024. LPA Kim conducted an audit of ten (10) resident files (R1-R10), ten (10) staff files (S1-S10), and medication and medication administration record were all in order and complete. LPA Kim conducted five (5) staff interviews and four (4) resident interviews. No deficiencies were cited during this visit. An exit interview was conducted, and a copy of this report was provided to Executive Director Maria Kauten.

Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPAs are unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED. LPAs conducted an interview with ED Kauten. A copy of this report was provided and explained.

Licensing Program Analyst (LPA) Jessica Cho and the Department's Investigations Branch Investigator (IBI) Hector Quintanar arrived unannounced for the purpose to conduct a case management visit at the facility. LPA and IBI interviewed Staff #1 (S1) in connection to Complaint Control Number: 22-AS-20231116152802 unrelated to this facility. An exit interview was conducted with Executive Director Maria Kauten, and copy of this report and the LIC811 were provided at the end of the visit.