107209036-11-16-2023-24-AS-SPIY-CYAPUR-20231207103758

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107209036
Report Date: 11/16/2023
Date Signed: 11/16/2023 03:41:24 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
08/08/2023 and conducted by Evaluator Katie Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20230808141453

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: 77	DATE:	11/16/2023
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Andrea Yescas		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Personal Rights
Lack of care and/or supervision
Violations related to Maintenance and Operation
Violations related to Incidental Medical and/or Dental Care
Training Requirements

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct a subsequent complaint investigation. LPA met with Memory Care Director (MCD) Andrea Yescas. During this visit, LPA conducted resident interviews and reviewed staff records.

The Department investigated the allegations ablove. LPA conducted multiple visits to the facility during the course of this investigation. R1 was observed each time to be clean and in clean clothing. During these visits, R1 was observed using the public telephone, watching television, participating in group activities or eating in the dining room. R1's room and bathroom were clean during LPA visits. Photos were provided of a brown substance which may have been feces on the toilet and surrounding areas. Staff interviewed state that this may occur due to R1 and R2 using the toilet independently without being able or aware of sufficient cleaning. LPA observed the chairs, tables and floors of the dining room to be clean during visit

See Lic9099-C for continuation of this report

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: 11/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023

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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Control Number 24-AS-20230808141453

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: OAKMONT OF NORTH FRESNO	FACILITY NUMBER: 107209036
	VISIT DATE: 11/16/2023

NARRATIVE

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Residents and staff were interviewed and did not report seeing or having knowledge of staff yelling at or treating residents inappropriately. Doors to resident rooms can be locked from either side but automatically unlock when the knob is turned from inside the room. Staff interviews and record review of charting notes and staff assignment forms reveal that R1 often refuses medications, physician ordered treatments and ADL care such as showers or hygiene assistance. LPA toured multiple resident rooms and did not find rooms to have permanent odor. Interviews revealed and LPA observed that R1 dresses self in multiple layers or mismatched clothing. Medication orders and medications were observed to be up to date. LPA observed documentation of communication with R1's Legal Guardian regarding medications and medical appointments. Night shift training records were observed to have met requirements.

Based on interviews conducted, LPA observations and record reviews the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur.

There were no citations issued

An exit interview was conducted and a copy of this report was left with MCD, whose signature confirms receipt of these documents.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie Brown	TELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023

LIC9099 (FAS) - (06/04)

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