107209036-8-30-2023-24-AS-SPIY-CVPQ9D-20230915115807

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107209036
Report Date: 08/30/2023
Date Signed: 08/30/2023 04:13:53 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/16/2023 and conducted by Evaluator Katie Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20230516174446

FACILITY NAME:	OAKMONT OF NORTH FRESNO		FACILITY NUMBER:	107209036
ADMINISTRATOR:	GUSTIN, PATRICIA		FACILITY TYPE:	740
ADDRESS:	5605 N GATES AVE		TELEPHONE:	(559) 277-5959
CITY:	FRESNO	STATE: CA	ZIP CODE:	93722
CAPACITY:	122	CENSUS: 76	DATE:	08/30/2023
		UNANNOUNCED	TIME BEGAN:	04:10 PM
MET WITH:	Heidi Setty		TIME COMPLETED:	04:11 PM

ALLEGATION(S):

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The facility did not conduct an assessment of resident prior to returning from the hospital with a change of condition

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Katie Brown arrived at the facility to deliver complaint investigation findings. LPA met with Administrator (AD) Heidi Setty.

Resident (R1) fell resulting in a fracture requiring surgery on 5/1/23. Based on interview, it was confirmed that the facility did not conduct an assessment or obtain required updated documentation of R1’s changes in condition or care needs prior to return to the facility on 5/6/23. The preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED.

Deficiencies are being cited in accordance with California Code of Regulations on the attached LIC 809-D.

An exit interview was conducted and Plan of Correction was developed. A copy of this report and Appeal Rights were discussed and left with AD, whose signature on this form confirms receipt of these documents.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie Brown	TELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

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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