315002955-8-13-2024-59-AS-KHOS-D8BJ7G-20240820064756

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315002955
Report Date: 08/13/2024
Date Signed: 08/13/2024 10:41:53 AM

Unfounded

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
06/12/2024 and conducted by Evaluator Bethany Mirlohi

COMPLAINT CONTROL NUMBER: 59-AS-20240612114234

FACILITY NAME:	OAKMONT OF WESTPARK		FACILITY NUMBER:	315002955
ADMINISTRATOR:	THOMAS, HALEY		FACILITY TYPE:	740
ADDRESS:	2400 PLEASANT GROVE BLVD.		TELEPHONE:	(916) 545-8904
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95747
CAPACITY:	142	CENSUS: 84	DATE:	08/13/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Haley Thomas, Administrator		TIME COMPLETED:	10:50 AM

ALLEGATION(S):

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Facility fail to ensure care to resident.
Staff overly medicated resident.
Staff is not qualified to conduct registered nurses' tasks.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to deliver complaint investigation findings. LPA met with Administrator Haley Thomas during today’s inspection.
LPA investigated the allegation, “Facility failed to ensure care to resident.” LPA interviewed 13 caregivers in which they stated they help provide care to R1. In addition, R1 has a private caregiver to ensure care is being provided. LPA interviewed family member in which they stated R1 receives care from the staff at the facility and a private caregiver. Family member had no concerns with the care being provided. LPA interviewed 5 residents in care in which they stated they receive care and help when needed and had no further concerns.
Continuation 9099-C.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Mirlohi	TELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

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 59-AS-20240612114234

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: 315002955
	VISIT DATE: 08/13/2024

NARRATIVE

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Due to the information gathered, LPA finds allegation to be UNFOUNDED.

LPA investigated the allegation, “Staff overly medicated resident”. LPA interviewed staff, and reviewed resident documentation. LPA interviewed 13 staff members, all staff stated there are no concerns with resident’s being overly medicated. Staff reported they follow doctor orders and only provide medications as prescribed. LPA reviewed R1’s medication orders, physician’s report, and facility MAR. Documentation shows facility is providing R1 with medications as prescribed by the doctor. LPA interviewed a family member in which they stated R1 receives their medication as prescribed. Due to the information gathered. LPA finds allegation to be UNFOUNDED.

LPA investigated allegation, “Staff is not qualified to conduct registered nurses tasks.” LPA interviewed staff and reviewed resident documentation. Relevant party stated S1 reinserted R1’s catheter once it became dislodged. S1 is not a registered nurse or other health care professional. LPA reviewed R1’s documentation, in which it stated R1 did dislodge catheter and it was reported to the hospice agency who came out to treat R1. LPA interviewed 12 staff members in which they stated they have not observed S1 perform registered nurses tasks before. LPA interviewed family member in which it was reported to them that S1 did not reinsert residents catheter. Family member stated it could have been a different caregiver. LPA attempted to interview a potential witness but was unable to get a hold of them. Due to the information gathered LPA finds allegation to be UNFOUNDED.

A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview conducted.

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Mirlohi	TELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

LIC9099 (FAS) - (06/04)

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