107209036-10-16-2023-24-AS-SPIY-CWZKNQ-20231027080328

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107209036
Report Date: 10/16/2023
Date Signed: 10/16/2023 04:11:01 PM

Unsubstantiated

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
06/30/2023 and conducted by Evaluator Katie Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20230630095305

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:	10/16/2023
		UNANNOUNCED	TIME BEGAN:	09:34 AM
MET WITH:	Heidi Setty		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility has insufficient staffing to meet residents’ needs
Staff leave resident unattended for extended periods of time
Staff failed to provide a safe and comfortable environment for resident
Facility is malodorous

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct a subsequent complaint visit and deliver investigation findings to the facility. LPA met with and explained the reason for the visit with Administrator (AD) Heidi Setty.

The Department has investigated the allegations listed above. LPA observed Resident (R1) and R1's room which was found to be clean and odor free on 7/6/23 and 10/16/23. Furniture and assistive devices were stored appropriately and neatly. R1 was observed clean and resting comfortably in bed. LPA observed R1 properly positioned during meals. During this visit, LPA conducted staff and Hospice Nurse interviews. LPA reviewed R1's file including facility's daily Staff Assignment Log for June - October 2023, Housekeeping and staff schedules were also reviewed. Based on observation, interview and record review, the above allegations are UNSUBSTANTIATED. Although the allegatiosn may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur.

There were no citations issued An exit interview was conducted and a copy of this report was left with AD, whose signature confirms receipt of these documents.

Unsubstantiated

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: 10/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2023

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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