216804022-3-21-2023-21-AS-CMAZ-CQ8VFH-20230324162354

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216804022
Report Date: 03/21/2023
Date Signed: 03/21/2023 10:24:01 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/01/2022 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20221101155054

FACILITY NAME:	OAKMONT OF NOVATO		FACILITY NUMBER:	216804022
ADMINISTRATOR:	PIELSTICK, RIC		FACILITY TYPE:	740
ADDRESS:	1465 S. NOVATO BLVD.		TELEPHONE:	(628) 215-1200
CITY:	NOVATO	STATE: CA	ZIP CODE:	94947
CAPACITY:	118	CENSUS: 82	DATE:	03/21/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Ric Pielstick		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff do not prevent altercations between residents
Facility staff are not reporting incidents to licensing

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on the above captioned complaint allegations. LPA met with the Administrator and discussed the findings. This investigation included a thorough review of resident records and other documents; interviews with witnesses and staff; site visits to the facility. The following determinations are made: R1 and R2 were involved displayed aggressive behaviors with each other on many occasions while in care at the facility; Records show that the behaviors were addressed in the residents' care plans; Residents' care notes document reasonable steps taken by staff to deal with the aggressions; Most incidents were reported as required by 87211; Two incidents which were identified as not reported may not have rose to the level of requiring a report and sufficient information to make a determination of requirement to report was not found. Although the allegations may be true, or valid, based upon the documents reviewed and statements taken, there is not as preponderance of evidence to prove the allegations or, are not, true. Therefore, the allegations are UNSUBSTANTIATED.
No citations issued today. Report left.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Carla Martinez	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David Leibert	TELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023

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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