019201084-7-28-2023-15-AS-KHOS-CURPVX-20230816113952

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019201084
Report Date: 07/28/2023
Date Signed: 07/28/2023 02:02:25 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/20/2021 and conducted by Evaluator Alicia Delmundo

COMPLAINT CONTROL NUMBER: 15-AS-20211020093224

FACILITY NAME:	OAKMONT OF MARINER POINT		FACILITY NUMBER:	019201084
ADMINISTRATOR:	VADNAIS, GERRY		FACILITY TYPE:	740
ADDRESS:	2400 MARINER SQUARE DRIVE		TELEPHONE:	(510) 341-5959
CITY:	ALAMEDA	STATE: CA	ZIP CODE:	94502
CAPACITY:	80	CENSUS: 50	DATE:	07/28/2023
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	MIndy Han/Executive Director		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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-Facility staff fail to assist resident (R1) with ADLs.
-Facility staff withhold food and water from the resident (R1).
-Facility staff prohibit resident (R1) rom using facility phone
-Facility staff are verbally abusive to resident (R1)
-Facility staff fail to assist resident (R1) with incontinence care.
-Facility is short-staffed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Delmundo arrived unaanounced to continue the investigation of the above allegations, and close the complaint. LPA met with Executive Director Mindy Han, and informed the reason for visit.

On 10/20/21. LPA interviewed resident (R1), reviewed and obtained copies of resident's record, shower schedule, staff schedule, and made observation. On 6/01/23, 6/05/23, 6/24/23 and 6/26/23, LPA called R1's family member and hospice agency. On 10/01/21, 7/17/23, and on this day, 7/28/23, LPA interviewed staff (S1, S2, S3, S4, S5, S6, S7 and S8) and Executive Director.

Allegation: Facility staff fail to assist resident R1 with ADLs.
It was alleged that staff (S4 and S5) fail to assist R1 with showers and other ADLs, and wait for the hospice aide to come to assist with shower.
........continued on 9099C (page 2)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Alicia Delmundo	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023

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 15-AS-20211020093224

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: OAKMONT OF MARINER POINT	FACILITY NUMBER: 019201084
	VISIT DATE: 07/28/2023

NARRATIVE

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Page 2

Review of shower records showed residents' schedule of showers and signed by the assigned staff when done. All staff interviewed stated they assist residents with ADLs. S4 and S5 denied waiting for hospice staff to provide assistance with ADLs. R1 stated staff assist her as needed.

Allegation: Facility staff withhold food and water from R1.
It was alleged that S4 and S5 withhold food and water from R1.
Seven out of 8 staff interviewed stated they never withhold food and water from R1. S4 and S5 denied withholding food and water from R1. R1 stated staff gives her whatever she wants.

Allegation: Facility staff prohibit R1 from using facility phone.
it was alleged that every time R1's family member calls the facility, staff will say resident has dementia.
LPA interviewed R1 who stated she has cell phone, and she can use the facility phone if she wants. All staff interviewed stated facility has land line phone and cordless phone and residents are allowed to use. Incoming calls are given to the residents. LPA observed on 10/20/21 a resident using the facility land line phone.

Allegation: Facility staff are verbally abusive to R1.
It was alleged that when R1 ask for water, S4 and S5, tell R1 to go and drink water from the toilet bowl. S4 and S5 denied the allegation. The other 5 staff interviewed also denied the allegation, and stated either they have not work with S4 and S5 or never heard them tell R1 the allegation. R1 stated the staff were never abusive to her.

Allegation: Facility staff fail to assist R1 with incontinence care.
It was alleged that S4 and S5 wait for hospice aide to change R1's diaper.
During initial visit, LPA observed R1 clean and no smell of urine. R1 stated the staff assist her as needed. The 7 staff interviewed stated residents are changed 2 to 3x during shift, promptly and as needed. S4 and S5 denied waiting for hospice aide to change R1's diaper.

...continued on 9099C (page 3)

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Alicia Delmundo	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 15-AS-20211020093224

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: OAKMONT OF MARINER POINT	FACILITY NUMBER: 019201084
	VISIT DATE: 07/28/2023

NARRATIVE

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Page 3

Allegation: Facility was short staffed.
All 7 staff stated they are able to do their duties. There were times when staff may call off or leave early, but management called for back-up and at times worked on the floor. One out of 7 staff interviewed stated this has changed recently and management is cutting staff hours to save on budget.

Based on all information gathered and due to LPA unable to obtain information from R1's family member and hospice staff, the 6 allegations are closed as unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegations may have happened or are valid, there are not a preponderance of the evidence to prove that the alleged violations occurred.

No deficiency cited.

Exit interview conducted and copy of this report provided.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Alicia Delmundo	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023

LIC9099 (FAS) - (06/04)

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