342700796-1-19-2022-27-AS-CACL-CB9RW3-20220202122228

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700796
Report Date: 01/19/2022
Date Signed: 01/19/2022 04:47:11 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
12/02/2021 and conducted by Evaluator Christopher Hopkins-Clarke

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20211202124038

FACILITY NAME:	OAKMONT OF EAST SACRAMENTO		FACILITY NUMBER:	342700796
ADMINISTRATOR:	ERVIN, TERENCE		FACILITY TYPE:	740
ADDRESS:	5301 F STREET		TELEPHONE:	(916) 905-2400
CITY:	EAST SACRAMENTO	STATE: CA	ZIP CODE:	95819
CAPACITY:	214	CENSUS: 138	DATE:	01/19/2022
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Terry Ervin		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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-Resident is not allowed to leave facility

INVESTIGATION FINDINGS:

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On January 19, 2022 at 3:00pm Licensing Program Analyst (LPA) Chris Hopkins conducted a office meeting via Microsoft Teams to deliver complaint findings. Present in the Teams meeting were Licensing Program Manager (LPM) Czarrina Camilon-Lee, Executive Director Terry Ervin, and Assistant Executive Director Michael Clymo.

Regarding the allegation of Resident is not allowed to leave facility, the Department found the following: based on record review and interviews, Resident 1 (R1) has a Power Of Attorney (POA) that he/she chose, and is not court appointed. This POA is strictly for Health Care and Financial decisions. Referring to the Department's Provider Information Notice (PIN) 21-48-ASC that was sent out on November 17, 2021, which gives guidance regarding the authority of conservators and agents under powers of attorney related to specific residents' rights.

Report continued on LIC9099C...

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-Clarke	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20211202124038

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: 01/19/2022

NARRATIVE

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R1 does not have a conservator only a POA. In reference to Health and Safety Code 1569.698(f), Any person who is not a conservatee and is entering a locked or secured perimeter facility pursuant to this section shall sign a statement of voluntary entry. The facility shall retain the original statement and shall send a copy of the statement to the department. R1 has expressed to the Ombudsman and LPA that he/she does not want to live in this facility and that he/she wants to go home.

Based on interview and record review, the preponderance of evidence standards has been met, therefore, the above allegation(s) is/are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies are being cited on the attached 9099D during this visit. Exit interview held, Appeal Rights discussed and given, Copy of report given.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-Clarke	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2022

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20211202124038

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: 01/19/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed Type A 01/20/2022 Section Cited HSC 1569.698(f)	1 2 3 4 5 6 7	Building standards; adoption; locked and secured perimeters in residential care facilities; persons with dementia 1569.698 (f) Any person who is not a conservatee and is entering a locked or secured perimeter facility pursuant to this section shall sign a statement of voluntary entry. The facility shall retain the original statement and shall send a copy of the statement to the department. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator has agreed to create and send a plan for POC by close of business 1/20/22.
	8 9 10 11 12 13 14	Based on interview and record review, the Licensee did not ensure that R1 voluntarily signed a statement wanting to live in this facility, being that R1 is not conserved. This poses an immediate threat to the Health, Safety, and Personal Rights of the residents in care.	8 9 10 11 12 13 14
Request Denied Type A 01/20/2022 Section Cited CCR 87468.1(a)(6)	1 2 3 4 5 6 7	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:	1 2 3 4 5 6 7	Administrator has agreed to create and send a plan for POC by close of business 1/20/22.
	8 9 10 11 12 13 14	Based on interview, R1 expressed to a couple of parties that he/she wanted to leave 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.	8 9 10 11 12 13 14

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-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-Clarke	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2022

LIC9099 (FAS) - (06/04)

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