312700863-10-3-2022-25-AS-KHOS-CK3U76-20221010151924

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700863
Report Date: 10/03/2022
Date Signed: 10/03/2022 11:37:07 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/29/2022 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 25-AS-20220629154519

FACILITY NAME:	OAKMONT OF WESTPARK		FACILITY NUMBER:	312700863
ADMINISTRATOR:	ATONETTE EDWARDS		FACILITY TYPE:	740
ADDRESS:	2400 PLEASANT GROVE BLVD		TELEPHONE:	(916) 789-2000
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95747
CAPACITY:	142	CENSUS: 105	DATE:	10/03/2022
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Jessica Pryor		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility staff not checking on residents.
Staff giving false statements to people.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 10/03/22 to deliver findings of the complaint investigation for above allegations. LPA met with administrator Jessica Pryor and explained the purpose of the visit. Prior to the visit , LPA completed required COVID-19 testing protocols and the daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA wore the following Personal Protective Equipment (PPE) during today's visit-surgical mask. LPA was screened by facility staff upon entry.

The department conducted records review ,facility observations and interviews to investigate the complaint.

**Report continued on LIC9099-C**

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

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 25-AS-20220629154519

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: OAKMONT OF WESTPARK	FACILITY NUMBER: 312700863
	VISIT DATE: 10/03/2022

NARRATIVE

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**report continued from 9099-----

Allegation- Facility staff not checking on residents.

The department conducted interviews, facility observation and record review to investigate above allegation. On 06/25/2022, R1 sustained an unwitnessed fall. R1 was found by staff and sent out to local hospital. There is no information that indicates the facility did not check on R1 timely and documentation indicates the facility sought timely medical care. therefore this allegation is UNFOUNDED.

Allegation- Staff giving false statements to people.

The department conducted interviews, facility observation and record review to investigate above allegation. Department conducted interviews with facility staff and residents to investigate this allegation. During interviews, staff indicated the facility reported R1’s fall to CCL and sought timely medical treatment for R1’s injuries. Department reviewed submitted incident reports by the facility and found the facility submitted an incident report for R1 timely, therefore this allegation is UNFOUNDED.

Based on information above, department concluded that all these allegations are UNFOUNDED, A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis.

No citations were issued today. Exit interview was conducted with Administrator and a copy of this report was provided to the facility. The signature of the Administrator on these forms acknowledges receipt of these documents.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

LIC9099 (FAS) - (06/04)

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