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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 312700863
Report Date: 10/24/2023
Date Signed: 10/24/2023 03:34:28 PM

Unsubstantiated


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
01/26/2023 and conducted by Evaluator Bethany Mirlohi
COMPLAINT CONTROL NUMBER: 25-AS-20230126165952
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:
10/24/2023
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:William P. Gallaher, Chief Executive OfficerTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility did not notice a change in resident's condition.
Facility did not ensure resident was eating.
Facility did not seek medical attention for resident.
Facility did not meet resident's needs.
INVESTIGATION FINDINGS:
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This facility is currently closed therefore this report is being sent to the licensee via Certified Mail. On 06/05/2020, Oakmont of West Park LLC dba Oakmont of West Park closed due to a change of ownership.
LPA investigated the allegation of “Facility did not notice a change in resident's condition.” LPA reviewed facility resident records, hospital resident records, and interviewed facility staff. LPA observed resident moved into the facility in July 2022, and physician report indicated resident had a diagnosis of Alzheimer’s and fracture due to a previous fall. Facility needs and service plan indicated resident needed assistance with grooming, dressing, transfers, bathing, toileting, and medication management. On November 29, 2022, resident was seen by their primary care physician, and relevant party states resident was at baseline. Continuation on 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023
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 5
Control Number 25-AS-20230126165952
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: 10/24/2023
NARRATIVE
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Relevant party indicates that resident had a clear runny nose starting on December 1st and that resident received their flu and covid vaccine shot on December 1st. Facility records document on December 3rd that resident was not feeling well, facility staff helped feed him in his room, and resident had a cough. Facility records document that on December 6th, resident was not feeling well but resident had an appointment that day at 2:30 PM. Relevant party indicated on December 2nd, family came to visit resident and they were fully dressed in bed sleeping. On December 4th the relevant party indicated that responsible party was notified that resident had a running temperature and congested, and resident needed to see their doctor. Responsible party made a doctor’s appointment on December 6th for a checkup. On December 6th resident was seen by their physician, and then sent to the Emergency Department due to low oxygen saturation and a temperature. Resident was admitted to the hospital and passed away on 12/11/22. Hospital documents indicate resident was admitted for generalized weakness and flu like symptoms. Resident death certificate states the reason for death is respiratory failure, supraventricular tachycardia, and Influenza A.
LPA interviewed 9 facility staff members. Health Care Director stated the facility nurse indicated on December 3rd or 4th that resident was not feeling well and then the responsible party was notified and made a doctor appointment. Health Care director stated resident had a cough and fever but was still stable. Health Care Director stated that she saw resident on December 5th and resident was up in his wheelchair and nothing warranted for resident to be sent out to the emergency department. LPA interviewed 3 caregivers in which they indicated resident did have flu like symptoms and was not acting like himself a few days prior to his December 6th appointment. LPA interviewed 2 caregivers in which they stated resident appeared to have cold like symptoms but nothing severe and resident was eating like normal. Due to the information gathered LPA finds the allegation to be UNSUBSTANTIATED.

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

DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 25-AS-20230126165952
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: 10/24/2023
NARRATIVE
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LPA investigated allegation, “Facility did not ensure resident was eating.” LPA reviewed facility resident records, hospital resident records, and interviewed facility staff. On November 29, 2022, resident was seen by their primary care physician, and relevant party states resident was at baseline. Facility records document on December 3rd that resident was not feeling well, facility staff helped feed him in his room, and resident had a cough. Facility records document that on December 6th, resident was not feeling well but resident had an appointment that day at 2:30 PM. LPA interviewed 3 caregivers and they stated resident had a decline in appetite, was less involved in activities, and resident was more lethargic and sleepier. LPA interviewed 2 caregivers in which they stated resident appeared to have cold like symptoms but nothing severe and resident was eating like normal. LPA interviewed the health care director in which she stated she was not aware of any issues with resident’s appetite. Interviews with relevant parties indicate that responsible party was notified by health care director that resident had been eating in his room since December 2nd. Relevant party stated that the hospital made comments in which it looked like resident had not eaten in several days. LPA reviewed hospital documents and was unable to find documentation indicating that resident had not eaten in several days. Due to the information gathered, LPA finds allegation to be UNSUBSTANTIATED.

LPA investigated allegation, "Facility did not seek medical attention for resident." LPA reviewed facility resident records, hospital resident records, and interviewed facility staff. LPA observed resident moved into the facility in July 2022, and physician report indicated resident had a diagnosis of Alzheimer’s and fracture due to a previous fall. Facility needs and service plan indicated resident needed assistance with grooming, dressing, transfers, bathing, toileting, and medication management. On November 29, 2022, resident was seen by their primary care physician, and relevant party states resident was at baseline. Relevant party indicates that resident had a clear runny nose starting on December 1st and that resident received their flu and covid vaccine shot on December 1st.
Continuation 9099-C.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 25-AS-20230126165952
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: 10/24/2023
NARRATIVE
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Facility records document on December 3rd that resident was not feeling well, facility staff helped feed him in his room, and resident had a cough. Facility records document that on December 6th, resident was not feeling well but resident had an appointment that day at 2:30. Relevant party indicated on December 2nd, family came to visit resident and they were fully dressed in bed sleeping. On December 4th the relevant party indicated that responsible party was notified that resident had a running temperature and congested, and resident needed to see their doctor. Responsible party made a doctor’s appointment on December 6th for a checkup. On December 6th resident was seen by their physician, and then sent to the Emergency Department due to low oxygen saturation and a temperature. Resident was admitted to the hospital and passed away on 12/11/22. Hospital documents indicate resident was admitted for generalized weakness and flu like symptoms. Resident death certificate states the reason for death is respiratory failure, supraventricular tachycardia, and Influenza A.
LPA interviewed 9 facility staff members. Health Care Director stated the facility nurse indicated on December 3rd or 4th that resident was not feeling well and then the responsible party was notified and made a doctor appointment. Health Care director stated resident had a cough and fever but was still stable. Health Care Director stated that she saw resident on December 5th and resident was up in his wheelchair and nothing warranted for him to be sent out to the emergency department. LPA interviewed 3 caregivers in which they indicated resident did have flu like symptoms and was not acting like himself a few days prior to his December 6th appointment. LPA interviewed 3 caregivers stated resident had a decline in appetite, was less involved in activities, and resident was more lethargic and sleepier. LPA interviewed 2 caregivers in which they stated resident appeared to have cold like symptoms but nothing severe and resident was eating like normal. Due to the information gathered, LPA finds allegation to be UNSUBSTANTIATED.

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

DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 25-AS-20230126165952
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: 10/24/2023
NARRATIVE
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LPA investigated allegation, "Facility did not meet resident's needs." LPA reviewed facility resident records, hospital resident records, and interviewed facility staff. LPA observed resident moved into the facility in July 2022, and physician report indicated resident had a diagnosis of Alzheimer’s and fracture due to a previous fall. Facility needs and service plan indicated resident needed assistance with grooming, dressing, transfers, bathing, toileting, and medication management. Facility records document on December 3rd that resident was not feeling well, facility staff helped feed him in his room, and resident had a cough. Facility records document that on December 6th, resident was not feeling well but resident had an appointment that day at 2:30. Responsible party made a doctor’s appointment on December 6th for a checkup. On December 6th resident was seen by their physician, and then sent to the Emergency Department due to low oxygen saturation and a temperature. Resident was admitted to the hospital and passed away on 12/11/22. Hospital documents indicate resident was admitted for generalized weakness and flu like symptoms. LPA interviewed 2 caregivers in which they stated resident was acting at baseline and care was being provided to resident. LPA interviewed 2 caregivers in which they stated care was being provided but resident was more lethargic. LPA interviewed Health Care Director in which she stated nothing indicated resident needed to be sent out to the emergency Department, and care was being provided to resident. Due to the information gathered, LPA is unable to determine if facility did not meet resident's needs. LPA finds allegation to be UNSUBSTANTIATED.
Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are unsubstantiated.
LPA will mail a copy of the 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: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5