315002955-6-29-2023-59-AS-KHOS-CTDLBH-20230703083645

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315002955
Report Date: 06/29/2023
Date Signed: 06/29/2023 02:18:13 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
06/06/2023 and conducted by Evaluator Bethany Mirlohi

COMPLAINT CONTROL NUMBER: 59-AS-20230606153419

FACILITY NAME:	OAKMONT OF WESTPARK		FACILITY NUMBER:	315002955
ADMINISTRATOR:	EDWARDS, ANTONETTE		FACILITY TYPE:	740
ADDRESS:	2400 PLEASANT GROVE BLVD.		TELEPHONE:	(916) 545-8904
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95747
CAPACITY:	142	CENSUS: 100	DATE:	06/29/2023
		UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Antonette Edwards, Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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9

Facility did not provide requested records to resident's responsible party.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to deliver complaint findings. LPA met with Administrator Antonette Edwards during today's inspection.
During complaint investigation LPA interviewed administrator and relevant party. Relevant party stated on May 10th 2023, they faxed in a request for documents for R1. Documents were not released to requesting party until June 22nd 2023. Administrator stated R1's documents were in the storage area and it took time to find the requested documents. Although the documents have been released, at the time of the complaint documents had not been released. Due to this information LPA finds allegation to be UNSUBSTANTIATED.
Exit interview conducted.

Unsubstantiated

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: 06/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023

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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