312700602-9-25-2020-27-AS-APEZ-BTWVS8-20200929164105

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700602
Report Date: 09/25/2020
Date Signed: 09/25/2020 02:45:32 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/20/2020 and conducted by Evaluator Sarena Keosavang

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20200520133603

FACILITY NAME:	OAKMONT OF ROSEVILLE		FACILITY NUMBER:	312700602
ADMINISTRATOR:	SMITH, AUSTRIA		FACILITY TYPE:	740
ADDRESS:	1101 SECRET RAVINE PARKWAY		TELEPHONE:	(916) 771-6700
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95661
CAPACITY:	120	CENSUS: 90	DATE:	09/25/2020
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Austria Smith		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility staff did not safeguard a resident's personal property.

INVESTIGATION FINDINGS:

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On September 25, 2020, Licensing Program Analyst (LPA) Sarena Keosavang contacted the facility via telephone to commence a complaint investigation finding due to COVID-19 and pre-cautionary measures. LPA discussed the purpose of the call and the elements of the allegation with Austria Smith, Administrator.

During the Department’s course of investigation, the following pertinent documents were obtained: police report, photographs, facility staff and resident roster, facility staff interview statements, R1’s Physician’s Report, R1’s facility inventory form, R1’s LIC 621 Client/Resident Personal Property and Valuables form, and R1’s admission agreement.

Based on investigation conducted by the Department which include interviews. Complainant stated R1’s diamond ring went missing and suspects caregivers providing care to R1 had stolen the diamond ring.

*****Continue on LIC 9099C *****

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Sarena Keosavang	TELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2020

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 27-AS-20200520133603

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: OAKMONT OF ROSEVILLE	FACILITY NUMBER: 312700602
	VISIT DATE: 09/25/2020

NARRATIVE

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Complainant stated R1’s wedding ring is very tight fitted and would not easily slip off R1’s finger without someone removing it forcefully. LPA interviewed seven (7) facility staff and R1’s husband who resides in the assisted living side regarding the missing diamond ring. Based on statements received, management was notified, and a search was conducted by facility staff. Staff was unable to locate the diamond ring. LPA interviewed four (4) staff and received consistent statements. LPA interviewed Administrator and Memory Care Director regarding the missing diamond ring. Memory Care Director stated R1’s husband and daughter were notified right away when the missing ring was brought to his attention by staff. Administrator stated during admission the facility reviewed policy with future residents that expensive jewelry not be left with the resident and this is pointed out in the Residence Agreement under F3.

LPA reviewed R1’s admission agreement under F3 states, Oakmont shall not be responsible for the loss of any personal property belonging to you due to theft, fire, or any other causes, unless the loss or damage was caused by negligence of Oakmont or it’s employee.

Based upon the information obtained during the investigation. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation may have happened or is valid, therefore the allegation is deemed UNSUBSTANTIATED.

An exit interview was conducted with Austria Smith, Administrator. A copy of this report will be sent to Administrator via email. A signed copy of this report will be emailed to LPA.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Sarena Keosavang	TELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2020

LIC9099 (FAS) - (06/04)

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