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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 097005555
Report Date: 06/06/2024
Date Signed: 06/06/2024 10:42:54 AM

Substantiated


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
06/05/2024 and conducted by Evaluator Lavinia Muscan
COMPLAINT CONTROL NUMBER: 59-AS-20240605110103
FACILITY NAME:OAKRIDGE SENIOR CAREFACILITY NUMBER:
097005555
ADMINISTRATOR:DR. BENJAMIN FOULKFACILITY TYPE:
740
ADDRESS:2896 CENTERBURY CIRCLETELEPHONE:
(916) 933-0107
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:6CENSUS: 4DATE:
06/06/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Lenore AlexiusTIME COMPLETED:
10:41 AM
ALLEGATION(S):
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Licensee failed to report to the Department that the licensee filed for Bankruptcy.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Lavinia Muscan conducted an unannounced complaint visit and met with Administrator Lenore Alexius. It was alleged that the Licensee did not provide required notifications due to bankruptcy. The Licensee confirmed that they have filed for bankruptcy on May 21, 2024. The Licensee was informed that they are required to notify the department, the State Long-Term Care Ombudsman, all residents, and, if applicable, their legal representatives, in writing, within two business days of filing for bankruptcy. During today's visit a facility tour was conducted, and the food was inspected which identified an adequate food supply for the number of residents in the home.

Based on the evidence obtained, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22), is being cited on the attached LIC 9099D. Appeal rights were provided and exit interview conducted.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia MuscanTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
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
Control Number 59-AS-20240605110103
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: OAKRIDGE SENIOR CARE
FACILITY NUMBER: 097005555
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/20/2024
Section Cited
HSC
1569.686(a)(3)
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A licensee shall notify the department, the State Long-Term Care Ombudsman, all residents, and, if applicable, their legal representatives, in writing, within two business days of filing for bankruptcy. This requirement was not met as evidenced by:
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The Licensee agrees to notify all parties immediately and proof of notices are to be received by Community Care Licensing by POC due date 6/20/2024.
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The department was informed that the Licensee filed Chapter 11 Bankruptcy on May 21, 2024 and the Licensee did not notify the Department within a 2-day period. This poses a potential health and safety risk to residents 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: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia MuscanTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2