216804022-10-13-2023-21-AS-BMOS-CWQNGP-20231018102726

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216804022
Report Date: 10/13/2023
Date Signed: 10/13/2023 11:26:50 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
09/01/2023 and conducted by Evaluator Marisol Cuadra

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20230901102047

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: 91	DATE:	10/13/2023
		UNANNOUNCED	TIME BEGAN:	11:07 AM
MET WITH:	Liza Hix (Executive Director)		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff violated residents personal rights

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Cuadra and Rummonds arrived unannounced at the facility and met with Executive Director, Liza Hix to deliver findings regarding the complaint allegation above.

It was alleged that Staff violated residents’ personal rights. Per Reporting party, Staff (S1) held up two fists like they were going to punch resident (R1). LPA was provided with facility internal communication records of various incidents including the incident dated 8/31/23, LPA obtained statements of incident staff (S1 and S2). S1 detailed in a daily summary report an incident that occurred on 8/31/23 around 8:05am. Per email from S1, R1 came into the lobby approached S1 to request their name. Per the statement responded, they were wearing their name badge. However, S1 inquired about the reason for R1 requesting their name, when R1 became very aggressive and S1 informed that they walked away, since R1 was making accusations about S1 that did not apply to them.

Continued on LIC9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol Cuadra	TELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

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 21-AS-20230901102047

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: OAKMONT OF NOVATO	FACILITY NUMBER: 216804022
	VISIT DATE: 10/13/2023

NARRATIVE

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Continued from LIC9099...

Per email from S2, R1 approached S2 stating that S1 came up to R1 with two fists in their face saying, “you better not and go tell anything to Liza”. S2 responded that they will notify their supervisor. LPA also obtained Novato Police Department service call records dated 9/1/23 at 12:45pm, there was a service call ADV – Advice to Citizen due to a possible assault from staff with a final disposition of Unfounded. However, LPA reviewed incident report logs for this facility, and it was determined that incident reports were not submitted to CCL. Administrator could not provide proof that incidents were reported to CCL. LPA will address reporting requirements on a case management inspection. Based on confidential interviews with staff and residents, LPA obtained contradictory information from the parties involved that confirmed that there was an incident that violated personal rights. Although, during LPA’s interviews with S1, LPA observed that S1 speaks in a loud tone of voice that could be interpreted as intimating for others. However, there was no supporting evidence that staff violated residents’ personal rights. A finding that the complaint allegation “Staff violated residents’ personal rights” is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol Cuadra	TELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

LIC9099 (FAS) - (06/04)

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