107209036-12-12-2023-24-AS-SPIY-CYMMQ4-20231218084804

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107209036
Report Date: 12/12/2023
Date Signed: 12/12/2023 03:08:46 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
08/09/2023 and conducted by Evaluator Katie Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20230809115225

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:	12/12/2023
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Heidi Setty		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Lack of Care and/or supervision
Personal Rights
Staff does not safeguard resident's personal belongings
Staff does not record resident's medicaitons in log
General Food Service Requirements

INVESTIGATION FINDINGS:

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

During this visit, LPA observed Resident (R1's) apartment and lunch dining service. LPA also conducted interviews and obtained documents from R1's facility file for record review.

The Department conducted an investigation of the allegations stated above. Interview and record review reveal that R1's inventory list,has been maintained by a family member, not the facility. R1's apartment was toured on 8/9/23, 8/17/23, 11/16/23 and 12/12/23 where blankets, towels and a clean couch cover were observed. Soiled clothing was not observed in R1's closet or drawers on these dates. There are not Housekeeping records to indicate that services were or were not provided as reported. Based on interviews, R1's room and personal items are cleaned up daily to avoid R1 wearing soiled items.

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: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

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-20230809115225

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: 12/12/2023

NARRATIVE

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Interviews were conducted regarding staff taking pictures of residents on personal phones. Conflicting information was provided. Staff who were interviewed deny having knowledge of or taking resident pictures.

Record review of Medication Administration Records (MARs) from July, August, November and December 2023 record staff document when R1 takes or refuses medications.

Interviews and observation reveal that residents are served appropriate portions of food. Snacks are sscheduled and served throughout the day and are available are available in the Memory Care (MC) kitchen.

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 violations did or did not occur.

There were no citations issued

An exit interview was conducted and a copy of this report was emailed to AD who signed the reports.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie Brown	TELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC9099 (FAS) - (06/04)

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