312700863-12-29-2022-25-AS-LMUZ-CMYRF9-20230111115845

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700863
Report Date: 12/29/2022
Date Signed: 12/29/2022 09:33:37 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
07/18/2022 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 25-AS-20220718153421

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: 102	DATE:	12/29/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Business Office Director-Emily Kumpe		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff did not provide assistance to resident(s) in a timely manner.
Resident left in soiled clothing for an extended period of time.
Resident's linens were soiled with urine/feces.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 12/29/2022 to deliver findings of the complaint investigation for above allegations. LPA met with Business Office Director-Emily Kumpe 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: 12/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022

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-20220718153421

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: 12/29/2022

NARRATIVE

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**continued from LIC9099.............
Allegation- Staff did not provide assistance to resident(s) in a timely manner.
The Department reviewed the needs and service plan for R1 which indicated R1 is a fall risk. On 07/17/22, at approximately 7:00am, R1 was found in their room and appeared to have sustained a fall and was bleeding from back side of his head. Facility staff called 9-1-1 immediately and resident was sent out to hospital to seek medical treatment around 7.30am. Although R1 sustained a fall in the facility and was bleeding, facility staff took appropriate action and sought medical treatment timely. Department concluded that facility did seek medical help for R1 in timely manner to address any health related concerns for R1, therefore this allegation is UNFOUNDED.

Allegation- Resident left in soiled clothing for an extended period of time.

The department conducted facility review and interviews regarding this allegation. R1 had a fall incident at facility on 07/17/22 around 7am and R1 was transferred to hospital to seek medical care after the fall incident. From interviews and facility record review, it has been revealed that linens for R1 was soiled due to bleeding from back of their head after the fall. Facility staff stayed with R1 till EMS staff showed up to make sure that R1 was safe until ambulance came in. During facility visits by department, facility found to have enough supplies of clean linens and residents appeared to have clean linens. During interviews, residents did not bring any concerns regarding lack of clean linens at the facility, therefore, this allegation is UNFOUNDED.

Allegation- Resident's linens were soiled with urine/feces. UNFOUNDED.

The department conducted facility review and interviews regarding this allegation. R1 had a fall incident at facility on 07/17/22 around 7am and R1 was transferred to hospital to seek medical care after the fall incident. From interviews and facility record review, it has been revealed that linens for R1 was soiled after R1 urinated on floor after the fall incident and staff helped R1 to clean up. Facility staff stayed with R1 till EMS staff showed up to make sure that R1 was safe until ambulance came in. During facility visits by department, residents were appeared to be well groomed and in good care, therefore, this allegation is UNFOUNDED.

Therefore all above 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. Exit interview conducted. Copy of the report provided to facility.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022

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
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
07/18/2022 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 25-AS-20220718153421

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: 102	DATE:	12/29/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Business Office Director-Emily Kumpe		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Resident experienced fall causing an injury.

INVESTIGATION FINDINGS:

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Unsubstantiated

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: 12/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022

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-20220718153421

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: 12/29/2022

NARRATIVE

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***continued from LIC9099A..........******

Allegation- Resident experienced fall causing an injury. -UNSUBSTANIATED

Regarding the allegation of resident (R1) are sustaining injury due to an unwitnessed fall, the Department found the following: based on interviews and record review it was determined R1 had a unwitnessed fall in their room on 07/17/22 around 7am when R1 was getting ready for breakfast. Caregiver was conducting rounds on 07/17/22 noticed that R1 had a fall in the bathroom around 7am and called Nurse to assess. R1 was a resident in memory care unit and had poor safety awareness. Per needs and services plan, R1 was a fall risk however was able to ambulate unassisted. Although R1 sustained a fall which caused them injury, the Department has determined that R1’s fall was not a result of staff’s lack of care or supervision, therefore this allegation is UNSUBSTANIATED.

Based on interviews conducted by the Department and records review, the preponderance of evidence standards has not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview was conducted and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022

LIC9099 (FAS) - (06/04)

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