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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700796
Report Date: 07/22/2021
Date Signed: 07/22/2021 03:26:26 PM



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
03/23/2021 and conducted by Evaluator Tung Truong
COMPLAINT CONTROL NUMBER: 27-AS-20210323102353
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:214; 214CENSUS: 101DATE:
07/22/2021
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Terry Ervin, AdministratorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Facility is not providing safe accommodations for resident's
INVESTIGATION FINDINGS:
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On 7/22/2021, Licensing Program Analyst (LPA) Tung Truong conducted an unannounced visit to this facility to deliver finding for a complaint investigation received on 3/23/21. LPA Truong discussed the purpose of the visit and the elements of the allegation with Administrator, Terry Irvin.

During the course of this investigation, LPA conducted interviews and reviewed records. The investigation revealed that a homeless person climbed in through a window that was left open by the day shift staff. Staff (S1) stated that she heard a noise and found the homeless person in the activities room watching TV and eating a snack. S1 also stated that on separate incident, another homeless man has attempted to break in. Administrator Terry also admitted that these incidents did occurred.

Continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
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 5
Control Number 27-AS-20210323102353
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: 07/22/2021
NARRATIVE
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As a result of this investigation, LPA finds the allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6 and/or Health and Safety Code.

An exit interview was conducted with the Administrator. A copy of this report, LIC 9099-D, and Appeal Rights were provided.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20210323102353
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: 07/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/23/2021
Section Cited
CCR
80072(a)(2)
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80072 Personal Rights. Each client has the right to be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
This requirement is not met as evidenced by:
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The facility has iimplemented triple checks. Each staff is responisible for checking on doors and windows on each shift.
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Based on interviews and incident reports, the licensee did not provide safe accomodations to residents in care due to a homeless man able to entered the facility because a door was not locked. Staff later found the man sitting in the activity room eating a snack. Police was called to remove this man from the facility. This posses an immediate 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: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
03/23/2021 and conducted by Evaluator Tung Truong
COMPLAINT CONTROL NUMBER: 27-AS-20210323102353

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:214; 214CENSUS: 101DATE:
07/22/2021
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Terry Ervin, AdministratorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff left residents in soiled clothing for extended periods of time
Staff are not checking on resident's in a timely manner
Residents rooms are dirty
Residents laundry is not being done
Staff not providing adequate food service
INVESTIGATION FINDINGS:
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On 7/22/2021, Licensing Program Analyst (LPA) Tung Truong conducted an unannounced visit to this facility to deliver finding for a complaint investigation received on 3/23/21. LPA Truong discussed the purpose of the visit and the elements of the allegation with Administrator, Terry Irvin.

During the course of this investigation, LPA conducted interviews, observed the facility grounds and reviewed records. The investigation revealed that residents laundry is being done timely and food services is adequate. Residents (R1) and (R2) stated that they are happy with the laundry services . R1 and R2 stated that food is good and staff did a good job with cleaning and laundry. In addition, the investigation revealed the lack of evidence to substantiate that staff are not checking on resident's in a timely manner. Residents have no concerns with the care being provided.

Continued on 9099-C


Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021
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 5
Control Number 27-AS-20210323102353
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: 07/22/2021
NARRATIVE
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As a result of this investigation, LPA finds the above allegations to be UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.

An exit interview was conducted with the Administrator. A copy of this report was provided.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5