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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 092700750
Report Date: 05/14/2021
Date Signed: 05/14/2021 12:03:13 PM



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
12/04/2020 and conducted by Evaluator Melissa Lusby
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20201204150345
FACILITY NAME:OAKMONT OF EL DORADO HILLSFACILITY NUMBER:
092700750
ADMINISTRATOR:YOUNAN, HEATHERFACILITY TYPE:
740
ADDRESS:2020 TOWN CENTER WEST WAYTELEPHONE:
(916) 467-8330
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:129CENSUS: 78DATE:
05/14/2021
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Krystal JenkinsTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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9
Medication management is inadequate
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst Melissa Lusby arrived at the facility on Friday May 14, 2021 to deliver findings for the complaint investigation. LPA wore an N95 as part of covid-19 precautions. LPA identified herself and discussed the elements of the allegation.

Throughout the investigation, the Department determined that a facility staff (S1) was witnessed failing to provide residents their medication in a timely manner. Other facility staff reported the incident to management. Facility staff stated S1 did not take the job seriously and often stated, “I’ll get to it when I get to it.” On 3/19/2021, S1 was terminated due to continued medication errors, after being retrained on proper medication management. The allegation that Facility staff is falling to properly provide medication to residents is SUBSTANTIATED.
Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Melissa LusbyTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021
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 6
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
12/04/2020 and conducted by Evaluator Melissa Lusby
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20201204150345

FACILITY NAME:OAKMONT OF EL DORADO HILLSFACILITY NUMBER:
092700750
ADMINISTRATOR:YOUNAN, HEATHERFACILITY TYPE:
740
ADDRESS:2020 TOWN CENTER WEST WAYTELEPHONE:
(916) 467-8330
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:129CENSUS: 78DATE:
05/14/2021
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Krystal JenkinsTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff neglect resulted in a resident sustaining a pressure injury
INVESTIGATION FINDINGS:
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5
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9
10
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13
Licensing Program Analyst Melissa Lusby arrived at the facility on Friday May 14, 2021 to deliver findings for the complaint investigation. LPA wore an N95 as part of covid-19 precautions. LPA identified herself and discussed the elements of the allegation.
Based on interviews conducted, facility visits and documents reviewed, the Department finds the preponderance of evidence standard was not met. When R1 returned from the hospital a dime sized pressure ulcer was forming on his tailbone. He suffered a decline in his health. He was no longer able to ambulate, had poor circulation, did not eat well, now in a wheelchair and completely bedridden. Staff rotated him every 2 hours and was rotated more often due to a poor diet, and frequently having diarrhea. Hospice treated his wound by cleaning the area with a foam dressing. R1 dressing were changed daily. Staff was given direction on frequent rotations to monitor skin tears and pain. Facility staff did not neglect resident resulting in sustaining a pressure injury, UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Melissa LusbyTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 27-AS-20201204150345
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: 05/14/2021
NARRATIVE
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As a result of this investigation LPA finds allegation to be 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. Appeal rights were given. A copy of this report was left at the facility.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Melissa LusbyTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 27-AS-20201204150345
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: 05/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/17/2021
Section Cited
CCR
87465(a)(5)
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87465 Incidental Medical and Dental Care (a) A plan for incidental medical ... shall be developed by each facility...(5)The licensee shall assist residents with self-administered medications as needed
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Training was held on 3/24/2021 for all med techs and nurses. Facility provided copies of sign in sheet and training material. Citation cleared on site.
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This requirement was not met as evidenced by staff interviews. This is an immediate threat to the health and safety to clients 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.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Melissa LusbyTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
12/04/2020 and conducted by Evaluator Melissa Lusby
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20201204150345

FACILITY NAME:OAKMONT OF EL DORADO HILLSFACILITY NUMBER:
092700750
ADMINISTRATOR:YOUNAN, HEATHERFACILITY TYPE:
740
ADDRESS:2020 TOWN CENTER WEST WAYTELEPHONE:
(916) 467-8330
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:129CENSUS: 78DATE:
05/14/2021
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Krystal JenkinsTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Residents are not getting their needs met
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst Melissa Lusby arrived at the facility on Friday May 14, 2021 to deliver findings for the complaint investigation. LPA wore an N95 as part of covid-19 precautions. LPA identified herself and discussed the elements of the allegation.

Throughout the investigation, the Department learned that on 10/27/2020, a blister was reported to management on resident’s inner thigh. On 10/28/2020, Accent Care provided direction to treat the blister. No other blisters were noted. Facility staff notified the proper people once the blister was found, and the blister was treated appropriately. No future blisters were reported after the initial discovery. Residents are not getting their needs met is UNFOUNDED. A finding that the complaint is Unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview conducted. A copy of this report was left at the facility.
Unfounded
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Melissa LusbyTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 27-AS-20201204150345
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: 05/14/2021
NARRATIVE
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Based on LPAs observations and interviews which were conducted and recorded, the preponderance of evidence standards has been met, therefore, the above allegation is found to be SUBSTANTIATED.

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.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Melissa LusbyTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021
LIC9099 (FAS) - (06/04)
Page: 6 of 6