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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700796
Report Date: 07/21/2022
Date Signed: 07/21/2022 03:20:33 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/18/2022 and conducted by Evaluator Christopher Hopkins-Clarke
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20220218121925
FACILITY NAME:OAKMONT OF EAST SACRAMENTOFACILITY NUMBER:
342700796
ADMINISTRATOR:ERVIN, TERENCEFACILITY TYPE:
740
ADDRESS:5301 F STREETTELEPHONE:
(916) 905-2400
CITY:EAST SACRAMENTOSTATE: CAZIP CODE:
95819
CAPACITY:0CENSUS: 0DATE:
07/21/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Luis OlivasTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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-the facility failed to observed resident in care; as resident was malnourished, dehydrated, and developed pneumonia.
-Medications were not administered to resident as prescribed
-Requests for communication with staff were not responded to
-Resident with a higher level of care needs was retained at the facility
-Facility does not have sufficient staff resulting in resident care needs not being met
INVESTIGATION FINDINGS:
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On 7/21/22 at 9:30AM, Licensing Program Analyst (LPA) Chris Hopkins conducted an unannounced facility visit in regards to a complaint investigation with the above allegations. LPA Hopkins met with Executive Director Luis Olivas and explained the purpose of today's visit.

Regarding the allegation of the facility failed to observed resident in care; as resident was malnourished, dehydrated, and developed pneumonia, the Investigative Branch (IB) found the following: based on interview and record review, it was determined that Multiple staff and Connie’s daughter confirmed Connie had a history of refusing to eat and drink. Staff continued to offer Connie meals and beverages, but she was resistant to care. Medical records documented Connie repeatedly refusing food and drinks after being discharged from Oakmont. Staff denied observing signs Connie had pneumonia. Hospital staff were not able to confirm Connie developed pneumonia but was assessed as high risk and received antibiotic treatment as a precaution. Connie’s sodium level was high which could have been an indication of dehydration.
Report continued on LIC9099-C...

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-ClarkeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
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 6
Control Number 27-AS-20220218121925
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: OAKMONT OF EAST SACRAMENTO
FACILITY NUMBER: 342700796
VISIT DATE: 07/21/2022
NARRATIVE
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Regarding the allegation of Medications were not administered to resident as prescribed, the Department found the following: based on interview and record review, it was determined that Resident 1's (R1) prescription order which was ordered and faxed on 1/24/22 and received by Oakmont 1/24/22 per Nurse Practitioner, and R1 was already transferred to the hospital at this time.

Regarding the allegation of Requests for communication with staff were not responded to, the Department found the following: based on interview and record review, it was determined that Nurse Practitioner called the memory care unit on 1/18/22 and left a voicemail. Nurse Practitioner then called again on 1/19/22 and spoke with Staff 1 (S1).

Regarding the allegation of Resident with a higher level of care needs was retained at the facility, the Department found the following: based on record review it was determined that the initial assessment on R1 showed that Staff 2 (S2) assessed R1 and R1 was capable of grooming independently just needing reminders, bathing required assistance, and dressing required reminders. R1 was still at a Level 1 care according to the assessment. A care meeting was scheduled, but the memory care director went out on leave and soon after R1 was transferred to the hospital.

Regarding the allegation of Facility does not have sufficient staff resulting in resident care needs not being met, the Department found the following: based on interviews, it was determined that resident needs were being met. LPA spoke with 3 family contacts of 2 former residents and 1 current resident who has resided here 10/21/2020.

LPA has deemed the five allegations mentioned above as UNSUBSTANTIATED. Although the allegations may have happened and/or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted with Administrator Luis Olivas. A copy of this report was left with Administrator upon exit.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-ClarkeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/18/2022 and conducted by Evaluator Christopher Hopkins-Clarke
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20220218121925

FACILITY NAME:OAKMONT OF EAST SACRAMENTOFACILITY NUMBER:
342700796
ADMINISTRATOR:ERVIN, TERENCEFACILITY TYPE:
740
ADDRESS:5301 F STREETTELEPHONE:
(916) 905-2400
CITY:EAST SACRAMENTOSTATE: CAZIP CODE:
95819
CAPACITY:0CENSUS: 0DATE:
07/21/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Luis OlivasTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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9
-Questionable death
INVESTIGATION FINDINGS:
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This is an Amended document previously delivered on 7/21/22 at 9:30AM. Licensing Program Analyst (LPA) Chris Hopkins conducted an unannounced facility visit in regards to a complaint investigation with the above allegations. LPA Hopkins met with Executive Director Luis Olivas and explained the purpose of today's visit.

Regarding the allegation of Questionable death, the Investigative Branch (IB) found the following: based on record review, it was determined that Resident 1's (R1) death was listed as a natural case of vascular dementia with onset of years. No contributing factors were listed. Based on record review, this allegation is determined to be without a reasonable basis and is determined to be UNFOUNDED.

Exit interview conducted with Administrator Luis Olivas. A copy of this report was left with Administrator upon exit.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-ClarkeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
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 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/18/2022 and conducted by Evaluator Christopher Hopkins-Clarke
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20220218121925

FACILITY NAME:OAKMONT OF EAST SACRAMENTOFACILITY NUMBER:
342700796
ADMINISTRATOR:ERVIN, TERENCEFACILITY TYPE:
740
ADDRESS:5301 F STREETTELEPHONE:
(916) 905-2400
CITY:EAST SACRAMENTOSTATE: CAZIP CODE:
95819
CAPACITY:0CENSUS: 0DATE:
07/21/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Luis OlivasTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
-Medical attention for resident was not sought in a timely manner
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This is an Amended document previously delivered on 7/21/22 at 9:30AM. Licensing Program Analyst (LPA) Chris Hopkins conducted an unannounced facility visit in regards to a complaint investigation with the above allegations. LPA Hopkins met with Executive Director Luis Olivas and explained the purpose of today's visit.

Regarding the allegation of Medical attention for resident was not sought in a timely manner, the Investigative Branch (IB) found the following: based on interview and record review, it was determined that on 1/22/2022, Nurse Practitioner (NP) informed Oakmont staff that R1's labs showed R1 was dehydrated and to push fluids as much as possible. NP directed staff to send R1 out to the hospital ifvR1 refused to drink fluids or looked tired. Staff 1 (S1) reported R1 drank some water but “not enough.” Other staff stated R1 refused to eat and drink. Multiple staff also reported that R1 appeared “lethargic,” “tired,” and “weak.” There were emails from family members to staff indicating R1's health was declining. Oakmont did not send R1 to the hospital until 1/24/2022, following NP's order to the facility.
Report continued on LIC9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-ClarkeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 27-AS-20220218121925
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: OAKMONT OF EAST SACRAMENTO
FACILITY NUMBER: 342700796
VISIT DATE: 07/21/2022
NARRATIVE
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Due to R1 sustaining serious bodily injury, the violation warrants civil penalty assessments. At this time, the civil penalty assessments are under review, and a civil penalty determination is pending by the Department. Once civil penalty assessments have been determined, an LPA will return at a future date to assess the civil penalties. As a result of this investigation, the Department finds this 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. Deficiency cited on the LIC 9099-D, per Title 22 Regulations and appeals rights given. Exit interview was conducted, and copy of this report was provided to facility.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-ClarkeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 27-AS-20220218121925
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: OAKMONT OF EAST SACRAMENTO
FACILITY NUMBER: 342700796
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/22/2022
Section Cited
CCR
87465(j)
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87465(j): Incidental Medical and Dental Care: (j) In all facilities licensed for sixteen (16) persons or more... assuring that each resident receives needed first aid and needed emergency medical services and for assisting residents...This requirement was not met as evidence by:
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Administrator has agreed to do an in-service training regarding timely medical attention and when residents should be sent out. Administrator has agreed to schedule training by POC due date
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 Based on record review and interview the licensee did not ensure that R1 was sent to the hospital in a timely manner for change of condition until Nurse Practitioner sent the order for R1 to be sent out.
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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: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-ClarkeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 6