092700750-10-30-2023-59-AS-LMUZ-CXCTHS-20231107134513

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 092700750
Report Date: 10/30/2023
Date Signed: 10/30/2023 02:34:06 PM

Unsubstantiated

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
10/03/2023 and conducted by Evaluator Lavinia Muscan

COMPLAINT CONTROL NUMBER: 59-AS-20231003142229

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: 77	DATE:	10/30/2023
		UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Administrator Lydia Gravelyn		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff did not dispense medication to resident as prescribed.

INVESTIGATION FINDINGS:

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On 10/30/23, Licensing Program Analyst (LPA) Lavinia Muscan arrived at the facility unannounced to 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: Staff did not dispense medication to resident as prescribed.
Based on documents obtained and statements received, the department determined that there was insufficient evidence that staff did not dispense medication to residents as prescribed. Documents obtained show that all current medications were administered and logged correctly and were given to residents per their doctor's orders. Based upon the information obtained during investigation, the above allegation is 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 was conducted with Administrator and a copy of this report was provided to the facility.

Unsubstantiated

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: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

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 4

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
10/03/2023 and conducted by Evaluator Lavinia Muscan

COMPLAINT CONTROL NUMBER: 59-AS-20231003142229

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: 77	DATE:	10/30/2023
		UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Administrator Lydia Gravelyn		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff did not follow resident's diabetic diet.
Staff did not follow resident's care plan.
Staff did not adequately supervise resulting in residents wandering into resident's room and not leaving.
Staff did not provide resident a method of calling for assistance.
Staff did not meet resident's hygiene needs.
Staff did not meet resident's dental care needs.
Staff did not maintain resident's bathroom in a clean and sanitary condition.
Staff did not meet resident's toileting needs.
Staff did not meet resident's laundering needs.

INVESTIGATION FINDINGS:

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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: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

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

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 59-AS-20231003142229

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: 10/30/2023

NARRATIVE

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Staff did not follow resident's diabetic diet.
Department conducted interviews with residents and staff to investigate this allegation. Interviews indicated that residents were happy with dietary services at the facility and did not indicate any issues. Based on the record review for R1’s physician's reports and review of preadmission records, there are no dietary restrictions for R1, 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.

Staff did not follow resident's care plan.Based on records reviewed and interviews, care plans are followed. LPA observed residents in care have care plans that are up to date and address their care needs as documented. Staff interviewed were able to demonstrate knowledge of how to implement assistance identified in the care plan, 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.

Staff did not adequately supervise resulting in residents wandering into resident's room and not leaving.Based on interviews it was determined that residents in memory care that wander in other resident’s bedrooms are redirected back to their own rooms by staff. If residents continue to wander in other residents’ rooms, the doors are then locked from the outside so that residents cannot have access to other residents’ rooms. Residents' rooms have self-unlocking doors from the inside allowing residents to leave their room freely. Staff are aware of wandering in the memory care unit and address the issue as needed, 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.

Staff did not provide resident a method of calling for assistance.

Based on interviews and observation, the department finds that there are call buttons in all residents’ rooms as well as the option to wear a call button on your person. Residents and staff interviews did not indicate any issues with call light/button system at facility, 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.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia Muscan	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 59-AS-20231003142229

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: 10/30/2023

NARRATIVE

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Staff did not meet resident's hygiene needs.
Staff did not meet resident's dental care needs.
Staff did not maintain resident's bathroom in a clean and sanitary condition.
Staff did not meet resident's toileting needs.
Staff did not meet resident's laundering needs.
Based on interviews and observation, the department observed the facility to be clean and sanitary. During department visits on 10/11/23 and 10/18/23 the department did not find any dirty bedding. The facility did not observe to be malodorous including resident rooms, common areas and restrooms. Residents stated the caregivers clean the facility and take out the trash frequently. Residents stated that their hygiene, toileting and laundering needs are being met and that housekeeping, and the staff, do a great job, therefore, the allegations are UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis.

Exit interview was conducted with Administrator and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia Muscan	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4