092700750-10-11-2023-59-AS-LMUZ-CWKTXC-20231013150655

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 092700750
Report Date: 10/11/2023
Date Signed: 10/11/2023 10:25:51 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/05/2023 and conducted by Evaluator Lavinia Muscan

COMPLAINT CONTROL NUMBER: 59-AS-20231005145435

FACILITY NAME:	OAKMONT OF EL DORADO HILLS		FACILITY NUMBER:	092700750
ADMINISTRATOR:	GRAVELYN, LYDIA		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: 84	DATE:	10/11/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Administrator Lydia Gravelyn		TIME COMPLETED:	10:26 AM

ALLEGATION(S):

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Staff gave resident another resident's medication

INVESTIGATION FINDINGS:

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On 10/11/23, Licensing Program Analyst (LPA) Lavinia Muscan arrived at the facility unannounced to open and deliver complaint findings into the allegations listed above and met with Administrator Lydia Gravelyn.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

**Report continued on 9099-C**

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia Muscan	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023

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 59-AS-20231005145435

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: OAKMONT OF EL DORADO HILLS	FACILITY NUMBER: 092700750
	VISIT DATE: 10/11/2023

NARRATIVE

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Staff gave resident another resident's medication
Based on documentation reviewed and conversation with the facility representative, on 10/6/23, the facility received a medication delivered for R1 from PharMerica pharmacy. The medication bottle had R1’s name and information. The medication was for an antibiotic and not routine medications for R1. R1 was administered 4 days of the prescribed medications. R1’s responsible party (RP) was at the facility and was told the facility administered the medication to R1. R1’s RP questioned the facility why R1 was being administered an antibiotic because R1 was not prescribed the medication by their physician. Upon further investigation, the facility learned that PharMerica pharmacy labeled the medication incorrectly with R1’s information however the medication was for another individual. Once this was learned, the facility ceased administering the medication to R1 and R1’s physician was notified. R1 did not experience any side effects due to being administered this medication. Although the facility administered a medication that was not prescribed to R1, the medication was incorrectly labeled by the pharmacy therefore the allegation is UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis.

Exit interview conducted. Report left at facility.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia Muscan	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023

LIC9099 (FAS) - (06/04)

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