092700750-8-11-2022-25-AS-LMUZ-CHBPEE-20220815111500

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 092700750
Report Date: 08/11/2022
Date Signed: 08/11/2022 12:41:36 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/23/2021 and conducted by Evaluator DeAnna Williams-Lyons

COMPLAINT CONTROL NUMBER: 25-AS-20211123125816

FACILITY NAME:	OAKMONT OF EL DORADO HILLS		FACILITY NUMBER:	092700750
ADMINISTRATOR:	YOUNAN, HEATHER		FACILITY TYPE:	740
ADDRESS:	2020 TOWN CENTER WEST WAY		TELEPHONE:	(916) 467-8330
CITY:	EL DORADO HILLS	STATE: CA	ZIP CODE:	95762
CAPACITY:	129	CENSUS: 80	DATE:	08/11/2022
		UNANNOUNCED	TIME BEGAN:	12:17 PM
MET WITH:	Kathleen Olson, Executive Director		TIME COMPLETED:	12:18 PM

ALLEGATION(S):

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Staff are not adhering to the resident's care plan.
Staff not assisting residents with ADLs

INVESTIGATION FINDINGS:

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On August 11 2022, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to deliver findings for Complaint 25-AS-20211014164117. LPA met with Kathleen Olson, Executive Director and explained the reason for the visit. Prior to the visit, LPA conducted COVID -19 Pre-cautionary prescreening and wore a surgical mask while at the facility. LPA was also screened by front desk personnel. LPA investigated the allegation of “Staff not assisting residents with ADLs” and “Staff are not adhering to the resident's care plan.”

Based on interviews conducted, the facility admitted that R1’s needs were not being met between August 2021 through March 2022 due to the facility conducting an incorrect assessment of R1’s needs at the time of admittance. The facility conducted an internal audit of R1’s needs and service plan. The facility conducted a reappraisal on R1 in March 2022. As of this date, R1’s needs and service plan correctly indicate R1’s needs and facility are meeting R1’s needs at this time.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons	TELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022

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 25-AS-20211123125816

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: OAKMONT OF EL DORADO HILLS	FACILITY NUMBER: 092700750
	VISIT DATE: 08/11/2022

NARRATIVE

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Although the facility has since conducted a reassessment of R1’s needs, the facility did not meet R1’s needs during August 2021 through March 2022, therefore, the allegation is SUBSTANTIATED, meaning the preponderance of evident standards has been met.

Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies are being cited on the attached 9099D during this visit. Exit interview held, Appeal Rights discussed, copy of report given.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons	TELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 25-AS-20211123125816

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: OAKMONT OF EL DORADO HILLS	FACILITY NUMBER: 092700750
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/11/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/11/2022 Section Cited CCR 87506(C)(1)	1 2 3 4 5 6 7	Resident Records The licensee shall be responsible for storing active and inactive records and for safeguarding the confidentiality of their contents. The licensee and all employees shall reveal or make available confidential information only upon the	1 2 3 4 5 6 7	A Plan of how the facility will conduct assessments prior to placement of residents as well as a plan on how the facility will ensure care staff have knowledge of resident’s needs according to a resident’s needs and service plan.
	8 9 10 11 12 13 14	the resident's written consent or that of his designated representative.This was not done in a timely manner.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons	TELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022

LIC9099 (FAS) - (06/04)

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