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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700796
Report Date: 10/19/2022
Date Signed: 10/19/2022 04:23:51 PM

Unfounded


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
08/03/2022 and conducted by Evaluator Christopher Hopkins-Clarke
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20220803154907
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:
10/19/2022
UNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Luis OlivasTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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9
-Resident developed a UTI while in care, resulting in death
-Resident developed pressure injuries while in care
INVESTIGATION FINDINGS:
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13
On 10/19/22 at 1:05PM Licensing Program Analyst (LPA) Chris Hopkins arrived at this facility unannounced to conduct a complaint investigation regarding the above allegations. LPA met with Executive Director Luis Olivas and explained the purpose of the visit.

Regarding the allegation of Resident developed a UTI while in care, resulting in death, the Department found the following; based on record review, it was determined Resident 1 (R1) death certificate confirmed the cause of death was not due to UTI.

Regarding the allegation of Resident developed pressure injuries while in care, the Department found the following; based on record review and interview, it was determined that R1 had "redness" and skin opening and facility staff notified R1's doctor when this was discovered, which was on 3/30/22. R1 was transferred to the hospital 1 day after staff noted the redness and skin opening on 3/31/22.
Report continued on LIC9099-C...
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: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022
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 7
Control Number 27-AS-20220803154907
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: 10/19/2022
NARRATIVE
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Based on record review and interview, 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.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-ClarkeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 7
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
08/03/2022 and conducted by Evaluator Christopher Hopkins-Clarke
COMPLAINT CONTROL NUMBER: 27-AS-20220803154907

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:
10/19/2022
UNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Luis OlivasTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
-Resident sustained injuries unwitnessed falls while in care
-Resident developed an infection while in care
-Staff did not observe change in resident's condition while in care
-Staff did not provide medical attention to resident according to their physician's instructions while in care.
-Staff did not clean resident's bathroom in a timely manner
-Resident's medications were not refilled on a timely basis while in care
-Resident's personal possessions were not safeguarded while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
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13
On 10/19/22 at 1:05PM Licensing Program Analyst (LPA) Chris Hopkins arrived at this facility unannounced to conduct a complaint investigation regarding the above allegations. LPA met with Executive Director Luis Olivas and explained the purpose of the visit.

Regarding the allegation of Resident sustained injuries unwitnessed falls while in care, the Department found the following; based on record review, it was determined that R1 had a history of falls with a history of chronic C5 and T12 fractures. It is noted in R1's phyisicians report the chronic fractures. It could not be determined if R1 suffered injuries while in care.

Regarding the allegation of Resident developed an infection while in care, the Department found the following; based on record review, it was determined that R1 had recurrent UTI, which is defined as three or more UTI's within 12 months or two or more occurences within six months based on medical records obtained.
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: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022
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 7
Control Number 27-AS-20220803154907
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: 10/19/2022
NARRATIVE
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Regarding the allegation of Staff did not observe change in resident's condition while in care, the Department found the following; based on record review, it was determined that facility staff did observe residents change of condition and it was noted multiple times in R1's charting notes.

Regarding the allegation of Staff did not provide medical attention to resident according to their physician's instructions while in care, the Department found the following; based on record review, it was determined that staff attempted to get urine sample from R1 but were unsuccessful, so staff called R1's family and doctor to set up an appointment for UTI testing and lab work.

Regarding the allegation of Staff did not clean resident's bathroom in a timely manner, the Department found the following; based on interview, it was determined that staff could not determine if shampoo was spilled/ poured all over the shower floor or not.

Regarding the allegation of Resident's medications were not refilled on a timely basis while in care, the Department found the following; based on record review and interview, it was determined that Oakmont staff did inform R1's family that R1 needed medication. Family was informed on 3/2/22, R1 moved in the facility on 2/28/22. R1 moved in with low medications, the facility was unable to give proper notice due to R1 moving in with low amount of medications.

Regarding the allegation of Resident's personal possessions were not safeguarded while in care, the Department found the following; based on interview, it was determined that Oakmont staff was able to find R1's wheel chair the same day R1's family came to retrieve it.

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: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 7
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
08/03/2022 and conducted by Evaluator Christopher Hopkins-Clarke
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20220803154907

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:
10/19/2022
UNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Luis OlivasTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
-Staff did not provide a diabetic diet to resident while in care
-Resident was not assisted with incontinent care while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/19/22 at 1:05PM Licensing Program Analyst (LPA) Chris Hopkins arrived at this facility unannounced to conduct a complaint investigation regarding the above allegations. LPA met with Executive Director Luis Olivas and explained the purpose of the visit.

Regarding the allegation of Staff did not provide a diabetic diet to resident while in care, the Department found the following; based on interview, it was determined that staff did acknowledge R1 had a "special diet" but wasn't sure if all staff were following it due to Oakmont being short staffed. Staff still provided R1 with bread, pasta, and other high carb foods which turn into sugar.

Regarding the allegation of Resident was not assisted with incontinent care while in care, the Department found the following; based on interview, it was determined that R1 was at times "double diapered". R1's family did witness this on multiple occasions.
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: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 27-AS-20220803154907
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: 10/19/2022
NARRATIVE
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As a result of this investigation, the Department finds these allegations 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: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 27-AS-20220803154907
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: 10/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/28/2022
Section Cited
CCR
87625(b)(2)
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87625 Managed Incontinence (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (2) Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night. This requirement was not met as evidenced by:
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Administrator has agreed to do an in-service training with caregivers on incontinence care. Proof of training to be sent to LPA by POC due date.
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Based on interview the Licensee did not ensure that R1 was checked on throughout the night. Instead staff were "double diapering" R1. This poses a potential health and safety risk to residents in care.
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Type B
10/28/2022
Section Cited
CCR
87555(b)(7)
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87555 General Food Service Requirements (b) The following food service requirements shall apply:(7) Modified diets prescribed by a resident's physician as a medical necessity shall be provided. This requirement was not met as evidenced by:
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Administrator has agreed to do an in-service training with staff on diabetic diets. Proof of training to be sent to LPA by POC due date.
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Based on interview the Licensee did not ensure R1 was getting a complete diabetic diet. This poses a potential health and safety risk to residents in care.
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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: 10/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022
LIC9099 (FAS) - (06/04)
Page: 7 of 7