079201037-3-12-2025-15-AS-HHUL-DEWTSY-20250319145956

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079201037
Report Date: 03/12/2025
Date Signed: 03/12/2025 04:48:30 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
11/19/2024 and conducted by Evaluator Laura Hall

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20241119173024

FACILITY NAME:	GREEN PASTURES RESIDENCES LLC - OAKMONT MANOR		FACILITY NUMBER:	079201037
ADMINISTRATOR:	ALOOT, DONNIE		FACILITY TYPE:	740
ADDRESS:	1408 OAKMONT PL		TELEPHONE:	(925) 858-1870
CITY:	PITTSBURG	STATE: CA	ZIP CODE:	94565
CAPACITY:	6	CENSUS: 6	DATE:	03/12/2025
		UNANNOUNCED	TIME BEGAN:	04:30 PM
MET WITH:	Donnie Aloot, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Resident is being isolated

Resident care is being neglected

INVESTIGATION FINDINGS:

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On 3/12/2025 at 4:30pm, Licensing Program Analysts (LPAs), L. Hall and Carol Fowler arrived unannounced to deliver complaint findings for the allegations above. LPA met with Donnie Aloot, Administrator and explained the reason for the visit.

During the course of the investigation the Department conducted interviews with staff, witness, client, obtained and reviewed records.

Allegation: Resident is being isolated

Based on initial interview W1 was told by W2 that R1 was being left alone in the room with the door closed most of the day. Staff stated during interviews that R1 prefers to be left alone. Staff also stated the reason the door is closed is that R1 yells and screams, which disturbs the other residents.

Continued on LIC9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20241119173024

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: GREEN PASTURES RESIDENCES LLC - OAKMONT MANOR	FACILITY NUMBER: 079201037
	VISIT DATE: 03/12/2025

NARRATIVE

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Continued from LIC9099.

Allegation: Resident care is being neglected

Based on initial interview W1 was told by W2 that R1’s daily hygiene needs were not being met. S2 and S4 stated during interview that R1 refuses to bathe when asked. S2 and S4 also stated R1 becomes aggressive when staff try to conduct ADL’s. LPA reviewed case notes and text messages during record review and observed staff communicated with R1’s responsible party when R1 refused to bathe and when R1 was agitated. Based on interviews and record review staff attempts to provide daily care, however, R1 refuses. R1 no longer resides at the facility.

Based upon the information obtained during investigation. The above allegations are unsubstantiated. A finding that the complaint 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 conducted and a copy of report was given.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

LIC9099 (FAS) - (06/04)

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