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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 092700750
Report Date: 11/26/2024
Date Signed: 11/26/2024 10:52:59 AM

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
08/13/2024 and conducted by Evaluator Lavinia Muscan
COMPLAINT CONTROL NUMBER: 59-AS-20240813084712
FACILITY NAME:OAKMONT OF EL DORADO HILLSFACILITY NUMBER:
092700750
ADMINISTRATOR:GRAVELYN, LYDIAFACILITY TYPE:
740
ADDRESS:2020 TOWN CENTER WEST WAYTELEPHONE:
(916) 467-8330
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:129CENSUS: 89DATE:
11/26/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Lydia GravelynTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Medication errors
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/26/24, 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:
Based on documents obtained and statements reviewed for August 2024, the department determined that there was insufficient evidence that any medication errors have occurred. Documents obtained show that all current medications were administered and logged correctly for residents per their doctor’s orders. Eight staff interviews (8) indicated that staff were not aware of any medication errors. Six resident interviews (6) expressed no concerns with medication administration. 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 conducted. Report left with facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia MuscanTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
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 2
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
08/13/2024 and conducted by Evaluator Lavinia Muscan
COMPLAINT CONTROL NUMBER: 59-AS-20240813084712

FACILITY NAME:OAKMONT OF EL DORADO HILLSFACILITY NUMBER:
092700750
ADMINISTRATOR:GRAVELYN, LYDIAFACILITY TYPE:
740
ADDRESS:2020 TOWN CENTER WEST WAYTELEPHONE:
(916) 467-8330
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:129CENSUS: 89DATE:
11/26/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Lydia GravelynTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not following universal precautions
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/26/24, 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:
Based on documents obtained and statements reviewed, the department determined that the facility was following universal precautions. As a precaution during COVID outbreak an in-service to staff was done on proper handwashing and universal precautions. Any staff that experienced signs or symptoms were either sent home or told not to come into work until the symptoms subsided. Facility kept a log of all staff that was sick and when the symptoms resolved, and they could return to work. It was observed facility had required posters posted throughout the facility regarding infection control guidelines and observed facilities supply of PPE. Additionally, when staff returned to work staff was to wear a mask for the first few days 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 with facility.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia MuscanTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
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 2