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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 312700863
Report Date: 06/27/2023
Date Signed: 06/27/2023 04:05:43 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 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
04/12/2023 and conducted by Evaluator Bethany Mirlohi
COMPLAINT CONTROL NUMBER: 59-AS-20230412130752
FACILITY NAME:OAKMONT OF WESTPARKFACILITY NUMBER:
312700863
ADMINISTRATOR:JESSICA PRYORFACILITY TYPE:
740
ADDRESS:2400 PLEASANT GROVE BLVDTELEPHONE:
(916) 789-2000
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:0CENSUS: 0DATE:
06/27/2023
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:William P. Gallaher, Chief Executive OfficerTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff are not ensuring that resident's representative is being provided copies of resident's records.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bethany Mirlohi is delivering complaint findings concerning allegations listed above. The department investigated allegation, “Staff are not ensuring that resident’s representative is being provided copies of resident records”. LPA interviewed relevant parties, and facility representatives. Through interviews LPA learned R1 had paid facility a deposit for her room however resident did not move into the facility. Administrator stated resident never signed an admission agreement and never moved into the facility. Relevant party stated no one from the facility responded to her record request for 6 months.

Continuation on 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023
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 59-AS-20230412130752
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: OAKMONT OF WESTPARK
FACILITY NUMBER: 312700863
VISIT DATE: 06/27/2023
NARRATIVE
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Relevant party stated she eventually received a copy of the check that originally was given to the facility and copy of the refund check. LPA reviewed R1’s records and observed a pre-admission assessment. Relevant party indicated she did not receive a copy of the pre-admission assessment. Due to the information gathered, LPA finds the allegation to be SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies cited on 9099-D.

LPA will mail a copy of report to licensee. Licensee to review, sign, and return a signed report to CCL my mail or email. Please direct all correspondence regarding this complaint to the attention of Bethany Mirlohi at the Departments Regional Office:

9835 Goethe Road, Suite 100
Sacramento, CA 95827
Bethany.mirlohi@dss.ca.gov.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023
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
SACRAMENTO NORTH ASC, 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
04/12/2023 and conducted by Evaluator Bethany Mirlohi
COMPLAINT CONTROL NUMBER: 59-AS-20230412130752

FACILITY NAME:OAKMONT OF WESTPARKFACILITY NUMBER:
312700863
ADMINISTRATOR:JESSICA PRYORFACILITY TYPE:
740
ADDRESS:2400 PLEASANT GROVE BLVDTELEPHONE:
(916) 789-2000
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:0CENSUS: 0DATE:
06/27/2023
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:William P. Gallaher, Chief Executive OfficerTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility is not adhering to Admissions Agreement.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bethany Mirlohi is delivering complaint findings concerning allegations listed above. The department investigated allegation, “Facility is not adhering to Admissions Agreement”. LPA interviewed relevant parties, and facility representatives. Through interviews LPA learned R1 had paid facility a deposit for her room however resident did not move into the facility. Administrator stated resident never signed an admission agreement and never moved into the facility. Refunds were issued to R1’s spouse. Due to the information gathered, LPA finds allegation to be UNFOUNDED.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023
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 59-AS-20230412130752
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: OAKMONT OF WESTPARK
FACILITY NUMBER: 312700863
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/30/2023
Section Cited
CCR
87506(c)(1)
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(c) All information and records obtained from or regarding residents shall be confidential. (1) The licensee shall be responsible for storing active and inactive records and for safeguarding the confidentiality of their contents. The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative.
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No plan of correction due to facility no longer being licensed.
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This requirement is not met as evidenced by: Based on record review the licensee did not provide requesting party a copy of pre-admission appraisal which poses a potential health and safety risk to residents in care.
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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: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4