092700750-10-11-2021-25-AS-LMUZ-C7QN76-20211012101210

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 092700750
Report Date: 10/11/2021
Date Signed: 10/11/2021 02:24:13 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
09/22/2021 and conducted by Evaluator Michael Smith

COMPLAINT CONTROL NUMBER: 25-AS-20210922152324

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: 92	DATE:	10/11/2021
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Stephen MacDonald		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility staff did not safe guard a resident's property

Facility staff do not clean/sanitize a resident's room

INVESTIGATION FINDINGS:

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Prior to entering the facility, LPA Smith spoke with staff to pre-screen that the facility is COVID free. Analyst also self-screened for having no known symptoms or exposure. Analyst followed facility's screening protocols, wore a mask and maintained distance during the visit. LPA Smith conducted an unannounced complaint visit and met with Stephen MacDonald.

Allegations: Facility staff did not safe guard a resident's property
LPA reviewed a purchase order which indicated that a "Drive Medical Silver Sport 1 Wheelchair with Full Arms and Swing Away Removable Footrest Black" was ordered on February 6, 2020 to be sent to Oakmont ATTN: Tanya Jackson for R1. Tanya was the MCD at the time. The whereabouts of the wheelchair in the facility is unknown and could not be located during this investigation. Based on observation and documentation, this allegation is SUBSTANTIATED.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Michael Smith	TELEPHONE: (916) 208-7807
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2021

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 25-AS-20210922152324

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: 10/11/2021

NARRATIVE

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Facility staff do not clean/sanitize a resident's room
LPA reviewed photographic evidence showing R1s bed with what appears to be a rather large excrement spot consistent with a leak of a diaper or bed pad. It does not appear to have been cleaned. Based on the photographic evidence, this allegation is SUBSTANTIATED.

As a result of this investigation, LPA finds the allegations that facility staff did not safe guard a resident's property and facility staff do not clean/sanitize a resident's room to be SUBSTANTIATED. A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Michael Smith	TELEPHONE: (916) 208-7807
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 25-AS-20210922152324

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: 10/11/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/26/2021 Section Cited CCR 87217(b)	1 2 3 4 5 6 7	87217(b) -Safeguards for Resident Cash, Personal Property, and Valuables- Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. This requirement is not met as evidenced by: Based on written	1 2 3 4 5 6 7	Facility shall find, replace or reimburse R1s estate. This shall be done within 15 days. LPA will clear deficiency upon completion.
	8 9 10 11 12 13 14	documentation and interviews, licensee did not safeguard R1s wheelchair as it has gone missing and it's current location is unknown. This is in violation of this section. This poses a potential health and safety risk to residents in care.	8 9 10 11 12 13 14
Type B 10/18/2021 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303(a)- Maintenance and Operation -The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:. Based on photographic evidence and	1 2 3 4 5 6 7	Facility shall submit a plan of action to insure that this will not reoccur in the future. This shall be done within 7 days. Plan shall be sent to LPA to clear this deficiency.
	8 9 10 11 12 13 14	witness statement, licensee did not maintain R1s room in a clean and sanitary manner and is in violation of this section. This poses a potential health and safety risk to residents in care.	8 9 10 11 12 13 14

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: Michael Smith	TELEPHONE: (916) 208-7807
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2021

LIC9099 (FAS) - (06/04)

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