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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701121
Report Date: 10/19/2023
Date Signed: 10/19/2023 03:40:04 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/11/2023 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230911162731
FACILITY NAME:OAKMONT OF EAST SACRAMENTOFACILITY NUMBER:
342701121
ADMINISTRATOR:LUIS OLIVASFACILITY TYPE:
740
ADDRESS:5301 F STREETTELEPHONE:
(916) 905-2400
CITY:EAST SACRAMENTOSTATE: CAZIP CODE:
95819
CAPACITY:214CENSUS: 147DATE:
10/19/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Luis OlivasTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Staff are not providing a resident with a copy of financial statements
INVESTIGATION FINDINGS:
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On 10/19/2023 at 8:10 AM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with administrator, Luis Olivas and explained the purpose of the visit. The purpose of this visit is to deliver complaint finding for the allegation above. The current census is 147. A brief interview was conducted with administrator, Luis Olivas.

Allegation: Staff is not providing a resident with a copy of financial statements.
It was alleged that the staff is not providing a resident with a copy of financial statements. This investigation consisted of records reviewed, interviews with staff, residents, and the resident responsible party. Throughout the course of the investigation, it was learned that resident 1 (R1)’s first and second invoice statement was sent to (R1) responsible party (RP), who then will forward the invoice statement to (R1). During the investigation, it was learned through (R1) that the facility may have misinterpreted (R1) when (R1) told the facility that (R1) wants (R1) reporting party (RP) to also receive (R1) invoice statement.
Continued LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/11/2023 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230911162731

FACILITY NAME:OAKMONT OF EAST SACRAMENTOFACILITY NUMBER:
342701121
ADMINISTRATOR:LUIS OLIVASFACILITY TYPE:
740
ADDRESS:5301 F STREETTELEPHONE:
(916) 905-2400
CITY:EAST SACRAMENTOSTATE: CAZIP CODE:
95819
CAPACITY:214CENSUS: 147DATE:
10/19/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Luis OlivasTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Staff does not adequately keep record regarding a resident's expenses.
INVESTIGATION FINDINGS:
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On 10/19/2023 at 8:10 AM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with administrator, Luis Olivas and explained the purpose of the visit. The purpose of this visit is to deliver complaint finding for the allegation above. The current census is 147. A brief interview was conducted with administrator, Luis Olivas.

Allegation: Staff does not adequately keep record regarding a resident's expenses.
It was alleged that staff do not adequately keep records regarding a resident's expenses. This investigation consisted of records reviewed, interviews with staff, residents, and the resident responsible party. LPA Lee interviewed 7 out of 10 residents who have no concern with staff not adequately keeping record regarding residents’ expenses. Throughout the course of the investigation, on 08/29/2023 the facility provided (R1) with (R1) charges and payments ledger per (R1) request; however, it was learned that (R1) charges and payments ledger is not itemized to show what kind of care services and guest meal charges.
Continued LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20230911162731
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: OAKMONT OF EAST SACRAMENTO
FACILITY NUMBER: 342701121
VISIT DATE: 10/19/2023
NARRATIVE
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It was learned that (R1) was provided an account summary using a login portal. However, per healthy and safety code section 1569.884(b) (R1) is not receiving a monthly statement itemizing all separate charges incurred by the resident. It was also learned that (R1) request guest meal receipts to cross reference to (R1) invoice statement to itemized (R1) guest meal charges. Moreover, it was also learned that on 07/15/2023 (R1) was charged $15.00 for another resident guest meal and then the facility reversed the charges on 08/09/2023.

As a result, this allegation is SUBSTANTIATED. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted with and a copy of this LIC 9099, LIC 9099-D page and appeal rights provided to facility.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20230911162731
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: OAKMONT OF EAST SACRAMENTO
FACILITY NUMBER: 342701121
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/27/2023
Section Cited
CCR
1569.88(b)
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1569.884(b) Contents of residential care facility admission agreements
(b) A comprehensive description of, and the fee schedule for, all items and services not included in a single fee. In addition, the agreement shall indicate that the resident shall receive a monthly statement itemizing all separate charges incurred by the resident.

This requirement was not met as evidence by...


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POC cleared during today's visit. On 09/08/2023 Administrator modify ledger entries to show itemized entry for resident incurred fees. Facility will ensure that (R1) recieves itemized ledger monthly.
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Administrator did not ensure that a resident is receiving a monthly statement itemizing all separate charges incurred by the resident on resident's invoice statement.
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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) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20230911162731
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: OAKMONT OF EAST SACRAMENTO
FACILITY NUMBER: 342701121
VISIT DATE: 10/19/2023
NARRATIVE
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It was also learned from administrator Luis Olivas that (R1) invoice statement was emailed to (R1) responsible party per (R1) request. The investigation also revealed that the facility uses “Realpage” to manage resident invoices and the portal only can hold one email. On 08/29/2023, It was learned that the facility made the changes to (R1) portal to have statements sent to (R1) instead. Based on LPA Lee observation on 09/14/2023, it was confirmed that (R1) invoices delivery will be emailed to (R1) instead. Moreover, per administrator, Luis Olivas (R1) monthly invoice will be emailed to (R1) responsible party through Outlook. LPA Lee also interviewed 9 out of 10 residents who stated they have no concern with their financial statements.

Based on information provided through interviews and records reviewed, the allegation is deemed UNSUBSTANTIATED although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation staff is not providing a resident with a copy of financial statements.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5