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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201085
Report Date: 11/15/2024
Date Signed: 11/15/2024 06:27:20 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
07/05/2024 and conducted by Evaluator Lisha Holmes
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240705101641
FACILITY NAME:OAKMONT OF CONCORDFACILITY NUMBER:
079201085
ADMINISTRATOR:SOR, KIM SFACILITY TYPE:
740
ADDRESS:1401 CIVIC COURTTELEPHONE:
(925) 798-4004
CITY:CONCORDSTATE: CAZIP CODE:
94520
CAPACITY:121CENSUS: 89DATE:
11/15/2024
UNANNOUNCEDTIME BEGAN:
05:45 PM
MET WITH:Kashvi Patel, ConciergeTIME COMPLETED:
06:45 PM
ALLEGATION(S):
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Licensee does not ensure that facility call pendant system is functioning at all times for residents in care.

Staff do not respond to residents' requests for assistance in a timely manner.
INVESTIGATION FINDINGS:
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On 11/15/24 around 05:45 PM, Licensing Program Analyst (LPA) L. Holmes amended the report to update the allegations from 11/04/24 around 03:30 PM when LPA arrived unannounced to deliver the complaint findings for the above allegations. LPA met with San Sor, Executive Director (ED) and explained the purpose of the visit; ED approved Kashvi Patel, Concierge to sign the report.

During the course of the investigation LPA interviewed ED, Staff and Residents. LPA requested emails and other forms of communication that were sent to residents and responsible parties regarding Assisted Living (AL) pendant system and Memory Care (MC) call button; the documentation to include any communications that show the request for repairs and when repairs were completed for any outages. LPA requested Resident Roster, Staff Roster, current LIC 500 and LIC 500 dated 06/2024, Resident Council's agenda/minutes for 05/2024 and 06/2024, In-Service trainings, and Resident Council President's contact information.
Continued on LIC9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
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-20240705101641
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 CONCORD
FACILITY NUMBER: 079201085
VISIT DATE: 11/15/2024
NARRATIVE
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...continued from 9099 to amend and separate allegations.

Allegations: SUBSTANTIATED
Licensee does not ensure that facility call pendant system is functioning at all times for residents in care.
Staff do not respond to residents' requests for assistance in a timely manner.

Licensee does not ensure that facility call pendant system is functioning at all times for residents in care.
Documentation for In-Service Staff training did not include all Care Staff and Management for Pendant Response Times. Proof of notification that ensured all Staff, Families and Responsible Party’s were aware of the pendants malfunctioning and the processes until corrected was not provided to CCLD during the investigation. Interviews with Staff (S2, S3, S4, S6) and Residents (R1, R2, R3, R11) confirmed that the pendants weren’t working properly or consistently from June 2024 to October 2024.

Staff do not respond to residents' requests for assistance in a timely manner.
R1 stated that he/she had wait over and hour for a caregiver to come to the apartment. R3 stated that he/she has waited up to 30 minutes for Staff to respond. S2, S3, and S6 stated that if they needed a 2 person assist, for example if a Resident was in a wheelchair, the Care Staff would have to wait for a response to get assistance; the next Residents’ response time would be delayed as a result of the pendant not working properly.

Deficiencies 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 Kashvi Patel, Concierge.

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

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 15-AS-20240705101641
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 CONCORD
FACILITY NUMBER: 079201085
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/22/2024
Section Cited
CCR
87303(i)(1)(A)(B)(C)
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87303 Maintenance and Operation (i) Facilities shall have signal systems which shall meet the following criteria: (1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall...(A) Operate...(B) Transmit...(C) Identify...unit -This requirement is not met as evidenced by:


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ED agreed to continue to monitor the system for the call pendants systems, alert all parties of malfunctions, review regulation, provide in-service training to all staff, and submit a copy of training with staff signatures to CCLD by POC.
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Based on interviews, the Licensee did not comply with the regulation cited above by not ensuring that the call pendant was working properly at all times or alerting all Staff and Residences of the processes during the malfunction, and not providing care to residents’ in a timely manner which posed/poses a potential health and safety risk to persons in care.
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Type B
11/22/2024
Section Cited
CCR
87464(f)(1)
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87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). -This requirement is not met as evidenced by:
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ED agreed to assume responsibility or provide ongoing assistance with activities of daily living, medications, money management, or personal care.
for the residents' physical health, mental health, safety and welfare by reviewiewing the regulation, provide in-service training to all staff, and submit a copy of training with staff signatures to CCLD by POC.
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Based on interviews, the Licensee did not comply with the regulation cited above by not providing care to residents’ in a timely manner which posed/poses a potential health and safety 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: 11/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC9099 (FAS) - (06/04)
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