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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317000237
Report Date: 04/21/2023
Date Signed: 04/21/2023 03:52:24 PM


Document Has Been Signed on 04/21/2023 03:52 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



FACILITY NAME:OAKWOOD VILLAGE, INC.FACILITY NUMBER:
317000237
ADMINISTRATOR:CATHY DUSTINFACILITY TYPE:
740
ADDRESS:3388 BELL ROADTELEPHONE:
(530) 889-8122
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY:124CENSUS: 48DATE:
04/21/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Cathy DustinTIME COMPLETED:
04:15 PM
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On 4/21/2023 LPA Tryon visited the facility to do a case management visit regarding incident reports received, LPA received reports dated 4/15/2023 and 4/20/2023 regarding resident R1 having two separate falls.

LPA learned that R1 was taken to the Emergency Room after each fall. ER doctor would not do a complete work-up as R1's DNR stated comfort care only, so no reason was determined for R1's falls/increased loss of balance. At this time, hospice services have been initiated for R1. This will assist to monitor his medical issues, because he will have hospice professionals coming in to provide care. The hospice agency is going to look at possible medication changes to see if that can help.

R1 was not previously a fall risk and was very mobile around the community

It appears that the facility has reacted appropriately by sending R1 out right away and seeking assistance; and now hospice services will be initiated.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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