312700863-10-20-2022-25-AS-TORZ-CKHVY7-20221024165037

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700863
Report Date: 10/20/2022
Date Signed: 10/20/2022 12:58:28 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 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
05/04/2022 and conducted by Evaluator Kerry Hiratsuka

COMPLAINT CONTROL NUMBER: 25-AS-20220504135925

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: 88	DATE:	10/20/2022
		UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Jeff Sumabat, Regional Ops Specialist		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff failed to call 911 in timely manner

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Kerry Hiratsuka arrived at the facility unannounced to deliver the findings of the allegations above. LPA wore a surgical mask during visit. This complaint came in May 2022.

The department investigated the allegation “Staff failed to call 911 in timely manner." The department conducted interviews and reviewed resident facility file and resident medical files.

The department could not prove or disprove that staff failed to call 911 in a timely manner. Interviews indicate the resident was displaying normal behavior most of the morning. The resident then laid down on the floor by themself but appeared to be tired and not distressed. Facility staff put the resident in their bedroom and checked within 10 minutes and found the resident unresponsive.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry Hiratsuka	TELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 4

Control Number 25-AS-20220504135925

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: OAKMONT OF WESTPARK	FACILITY NUMBER: 312700863
	VISIT DATE: 10/20/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Facility staff called 911 and emergency personnel arrived and took over. The resident had several health conditions the facility was aware of. The allegation also had to do with who made the 911 call and where it was made within the building. The department determined who made the 911 call and what time. What cannot be determined is the time between the resident’s change of condition and the 911 call being made.

The department cannot prove or disprove the staff did not call 911 in a timely manner. Allegation is unsubstantiated.

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry Hiratsuka	TELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 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
05/04/2022 and conducted by Evaluator Kerry Hiratsuka

COMPLAINT CONTROL NUMBER: 25-AS-20220504135925

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: 88	DATE:	10/20/2022
		UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Jeff Sumabat, Regional Ops Specialist		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

1. Facility falsifying records
2. Staff not trained correctly in CPR.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Kerry Hiratsuka arrived at the facility unannounced to deliver the findings of the allegations above. LPA wore a surgical mask during visit. This complaint came in May 2022.

The department investigated the allegation “1. Facility falsifying records; 2. Staff not trained correctly in CPR.” The department conducted interviews and reviewed resident facility file and resident medical files.

1. The complainant stated the facility was lying about who made the 911 call. The department confirmed through interviews and staff schedule the facility staff who made the 911 call was working that day and did make the 911 call. The complainant also stated the facility is lying about who did CPR to the resident and that one who started doing CPR wasn’t doing it correctly and another caregiver had to step in and do CPR until emergency personnel arrived. Interviews indicate one caregiver did CPR for the majority of the time waiting for emergency personnel and had someone else take over for a very short time to give the original caregiver a break. Allegation is unfounded.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry Hiratsuka	TELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 25-AS-20220504135925

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: OAKMONT OF WESTPARK	FACILITY NUMBER: 312700863
	VISIT DATE: 10/20/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

2. The complainant stated the caregiver in question giving CPR to a resident was not doing it correctly and that another caregiver had to step in and do CPR. Interviews stated the caregiver in question did CPR the majority of the time waiting for emergency personnel to arrive and the caregiver took a very short break and had someone else do it and then took over again. The facility also submitted the caregiver’s CPR card. Allegation is unfounded.

“This agency has investigated the complaint alleging; 1. Facility falsifying records and
2. Staff not trained correctly in CPR. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis."

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry Hiratsuka	TELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 4