107209036-11-16-2023-24-AS-SPIY-D2PM2T-20240222081402

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107209036
Report Date: 11/16/2023
Date Signed: 11/16/2023 02:11:06 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
11/14/2023 and conducted by Evaluator Katie Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20231114150812

FACILITY NAME:	OAKMONT OF NORTH FRESNO		FACILITY NUMBER:	107209036
ADMINISTRATOR:	SETTY, HEIDI		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:	09:04 AM
MET WITH:	Nathaniel Dominguez		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Licensee did not abide by the terms of resident’s admission agreement.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct the initial 10-Day complaint investigation. Upon entry, LPA met with Marketing Director (MD) Mary Davis. Administrator (AD) Heidi Setty and Health Services Director (HSD) Nathaniel Domingues arrived shortly after. LPA explained the reason for the visit and the elements of the allegation.

During the visit, LPA conducted record review of Resident (R1's) file as well as interviewed AD and HSD.

Interviews reveal a discrepancy in whether proper notification of physician ordered lab work was communicated to R1’s Responsible Party. Facility charting notes and shift report document that a message was left by staff. Interview and record review of the Residence and Service Agreement (RSA) reveal that pharmacy designation is part of the admission process but not an element of the RSA.

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-20231114150812

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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Though medication was ordered from the wrong pharmacy, it was not found to be a violation of the agreement. The above allegation is UNSUBSTANTIATED. Although the allegation may have happened or is 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 AD, 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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