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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700796
Report Date: 03/14/2022
Date Signed: 03/14/2022 04:48:09 PM


Document Has Been Signed on 03/14/2022 04:48 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



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:214CENSUS: 131DATE:
03/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:35 PM
MET WITH:Terry ErvinTIME COMPLETED:
04:55 PM
NARRATIVE
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On March 14, 2022 at 3:35 PM Licensing Program Analyst (LPA) Chris Hopkins made an unannounced case management visit to follow up on complaint #27-AS-20211202124038 regarding Resident 1 (R1) update. A risk assessment call was performed prior to entry verifying there were no active covid cases. LPA was screened and then met with Executive Director Terry Ervin.

LPA observed R1 eating dinner. R1 has not been moved. There was an update on 3/11/22 from R1's POA's attorney stating that there is a scheduled hearing with the court on 3/22/22 regarding conservatorship. There was also an update from R1's treating physician stating that the physician is in support of conservatorship and placement.

The following deficiencies cited on the following 809D pursuant to title 22 rules and regulations, health and safety code.

Appeal rights were printed and given to facility staff and Exit Interview was conducted.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-ClarkeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 03/14/2022 04:48 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 03/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
03/16/2022
Section Cited
CCR
87468.1(a)(6)

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Personal Rights of Residents in All Facilities 87468.1 (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This does not prohibit a licensee from establishing house rules, such as locking doors at night to protect residents, or barring windows against intruders, with permission from the Department. This requirement was not met as evidenced by:
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Administrator has agreed to create and send a plan for POC by close of business 3/16/22.
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Based on interview and observation, R1 expressed to a couple of parties that he/she wanted to leave the facility. LPA has also observed R1 to still be residing in the facility. The Licensee did not ensure that R1's personal rights were being followed. This poses an immediate threat to the Health, Safety, and Personal Rights of the 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: 03/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2