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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201083
Report Date: 07/08/2025
Date Signed: 07/08/2025 12:18:28 PM

Substantiated


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
05/08/2025 and conducted by Evaluator Lisha Holmes
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250508114135
FACILITY NAME:MONTECITO OAKMONT SENIOR LIVINGFACILITY NUMBER:
079201083
ADMINISTRATOR:RICHARD PEILSTICKFACILITY TYPE:
740
ADDRESS:4756 CLAYTON ROADTELEPHONE:
(925) 692-5838
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY:230CENSUS: 186DATE:
07/08/2025
ANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Richard Pielstick, Executive DirectorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Facility does not have emergency plan.
INVESTIGATION FINDINGS:
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On 07/08/2025 around 10:00 AM, L. Holmes, Licensing Program Analyst (LPA), arrived unannounced to deliver the complaint findings for the above allegation. LPA met with Richard Pielstick, Executive Director and explained the purpose of the visit.

LPA interviewed staff and conducted a facility tour with Staff (S2 and S3), interviewed S1, S2 and S3 and Resident #1 (R1). LPA requested LIC602s, ID/Emergency contact information, and Death Reports for all residents that were oxygen dependent, emails and other communications to residents and responsible parties regarding power outage around 04/20/25, and the following documents: Current Personnel Report (LIC 500), LIC 500 dated 04/2025, Resident roster report, Emergency Disaster Plan, and/or invoices from vendors/PGE; April - May 2025 Resident Council notes, Emergency Disaster Plan, and Safety Drills.

Continued on LIC9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
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-20250508114135
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: MONTECITO OAKMONT SENIOR LIVING
FACILITY NUMBER: 079201083
VISIT DATE: 07/08/2025
NARRATIVE
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...continued from LIC9099C...

The allegation refers to a power outage that occurred on 04/20/25. R1 stated that a Care staff did in fact come to check on him/her once or twice, but residents did not have any flashlights available in their rooms that were provided by the facility, and that the halls were dark. S3 stated that there were 30 existing lanterns and about 20 more were purchased; however, the facility’s census during that time was 161. Interviews with S1 and S3 confirmed that only lanterns were provided in the hallways, and all corridor lights stayed on for 90 minutes which included the flood lights and every other ceiling light on each floor. The residents' apartments are not equipped with back-up lighting. LPA reviewed the facility's Emergency Disaster Plan (EDP) on file and it states that flashlights would be provided to residents.

Based on LPA’s interviews, observations, and records reviewed, the preponderance of evidence standard has been met; therefore, the above allegation is SUBSTANTIATED. Deficiency is cited from Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction by plan of correction due date, and any repeat violations within a 12-month period may result in civil penalties.

Exit interview conducted, appeal rights and a copy of this report provided to Richard Pielstick, Executive Director.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20250508114135
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: MONTECITO OAKMONT SENIOR LIVING
FACILITY NUMBER: 079201083
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/22/2025
Section Cited
CCR
87303(h)
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87303 Maintenance and Operation
(h) Emergency lighting shall be maintained. At a minimum this shall include flashlights, or other battery powered lighting, readily available in appropriate areas accessible to residents and staff. Open-flame lights shall not be used. -This requirement is not met as evidenced by:
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Licensee/ED to review regulation, EDP and/or provide flashlights/battery powered lighting to all resdents. Provide proof to CCLD by POC date.
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Based on interviews and review of inventory, the licensee did not comply with the section cited above by not having flashlights or battery powered lighting for residents in their rooms/apartments which posed a potential health, safety and/or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3