216804022-3-28-2024-21-AS-VBEI-D3YNWT-20240403105005

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216804022
Report Date: 03/28/2024
Date Signed: 03/28/2024 10:38:55 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 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
01/05/2024 and conducted by Evaluator Helena Rummonds

COMPLAINT CONTROL NUMBER: 21-AS-20240105103001

FACILITY NAME:	OAKMONT OF NOVATO		FACILITY NUMBER:	216804022
ADMINISTRATOR:	LIZA HIX		FACILITY TYPE:	740
ADDRESS:	1465 S. NOVATO BLVD.		TELEPHONE:	(628) 215-1200
CITY:	NOVATO	STATE: CA	ZIP CODE:	94947
CAPACITY:	118	CENSUS:	DATE:	03/28/2024
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Executive DIrector, Ric Pielstick		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Staff did not provide resident's responsible party with proper rate increase notice
Staff not following terms of admission agreement

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Helena Rummonds arrived unannounced at approximately 9:15AM to deliver findings regarding the above complaint allegations. LPA met with Executive Director, Ric Pielstick.

Complaint alleges that staff are not following terms of admission agreement, and that staff did not provide resident's responsible party with proper rate increase notice.

Review of documentation revealed that residents responsible party and facility came to the agreement of $3,095/month for standard rent. Review of documentation revealed that resident was assessed before move in on 08/24/2023 with 25 billable points leaving their cost of care at $855 a month, in addition to their base rate of $3,095 leaving their total monthly payment including rent and cost of care at $3,950.

Continued on LIC9099C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Helena Rummonds	TELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

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-20240105103001

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: OAKMONT OF NOVATO	FACILITY NUMBER: 216804022
	VISIT DATE: 03/28/2024

NARRATIVE

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Continued from LIC9099

However, facility personnel inquired to the responsible party on 12/8/2023 informing them that their rent was being charged at an incorrect base rate of $3,530 in the months of August and September and that it was being updated to reflect the proper agreed upon rate of $3,095. With these rates, the responsible party had been charged $435 more a month than what was outlined in the admission agreement.

Facility conducted a reassessment on 10/02/2023 with 126 billable points leaving the residents cost of care at $2,520 a month. Review of documentation revealed that facility personnel were requesting backpay for a cost of care increase in the months of August and September despite the reassessment being dated 10/02/2023. Review of documentation revealed that there was a Cost of Care Communication created on 10/03/2023. However, facility was unable to prove that this was provided to the resident’s responsible party prior to 12/8/2023. Therefore, the above allegations are SUBSTANTIATED.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Exit interview conducted. Copy of report, LIC809D, Plan of Corrections, and Appeal Rights discussed and provided to Executive Director. Signature on forms confirms receipt of documents.

SUPERVISOR'S NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Helena Rummonds	TELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20240105103001

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: OAKMONT OF NOVATO	FACILITY NUMBER: 216804022
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/28/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed Type B 04/09/2024 Section Cited HSC 1569.657(a)	1 2 3 4 5 6 7	(a) For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative...written notice of the rate increase within two business days ... This requirement was not met as evidenced by:	1 2 3 4 5 6 7	ED agrees to review the requirements of HSC1569.657 and submit to LPA a signed and dated declaration addressing how facility will comply with the regulation going forward. Declaration to be submitted to LPA by POC due date of 04/09/2024.
	8 9 10 11 12 13 14	Based on document review, facility did not ensure a proper rate increase notice was provided within two days to resident and/or their responsible party as required by regulation.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Helena Rummonds	TELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

LIC9099 (FAS) - (06/04)

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