342701121-10-24-2023-27-AS-KHOS-CY4PXF-20231201104215

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701121
Report Date: 10/24/2023
Date Signed: 10/24/2023 03:07:37 PM

Substantiated

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
10/10/2023 and conducted by Evaluator Pang Lee

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20231010102244

FACILITY NAME:	OAKMONT OF EAST SACRAMENTO		FACILITY NUMBER:	342701121
ADMINISTRATOR:	LUIS OLIVAS		FACILITY TYPE:	740
ADDRESS:	5301 F STREET		TELEPHONE:	(916) 905-2400
CITY:	EAST SACRAMENTO	STATE: CA	ZIP CODE:	95819
CAPACITY:	214	CENSUS: 147	DATE:	10/24/2023
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Luis Olivas		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff do not respond to resident(s) call bells in a timely manner.

INVESTIGATION FINDINGS:

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On 10/24/2023 at 1:15 PM, 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 conducted with administrator, Luis Olivas.

Allegation: Staff do not respond to resident(s) call bells in a timely manner.
It was alleged that Staff does not respond to resident(s) call bells in a timely manner. This investigation consisted of records reviewed, interviews with staff, residents, and the resident responsible party. LPA Lee interviewed 7 out of 10 residents who has a concern in regards to staff not responding to resident’s call pendant in a timely manner. It was also learned that occasionally the alert was not responded; therefore, it is unclear if residents receive the support that residents needed. On 10/19/2023, it was learned that per a family member request a meeting was held on 10/19/2023 at 12:30 PM, in regards to staff not responding and attending to residents call pendant.
Continued LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

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-20231010102244

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: 10/24/2023

NARRATIVE

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During this meeting it was learned that VP of Operations Terry Ervin acknowledge that the facility can do better in responding to resident calls. It was also learned from administrator, Luis Olivas and VP of Operation, Terry Ervin stated that the facility response time is between 15 minutes or less. LPA Lee requested and reviewed 10 residents Personal Health Button Report (PHBR). The documents revealed that 3 residents (PHBR) were not responded within 15 minutes or less minutes per administrator, Luis and VP of Operation, Terry. Furthermore, the documents also revealed that 7 residents (PHBR) stated that residents’ calls were ever respond to.

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 administrator and a copy of this LIC 9099, LIC 9099-D page and appeal rights provided to facility.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20231010102244

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: 10/24/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/07/2023 Section Cited CCR 87303(i)(1)(B)	1 2 3 4 5 6 7	87303(i)(1)(B) Maintenance and Operation (i) Facilities shall have signal systems which shall meet the following criteria: (1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall: (B) Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff. This requirement was not met as evidence by:	1 2 3 4 5 6 7	Effective immediately the administrator will start reviewing Personal Health Button Report (PHBR) and conduct an audit and ensure to conduct additional training with facility staff; furthermore, ongoing training will also be conducted. Administrator also agrees to submit proof of training and the training materials used along with staff sign in sheet.
	8 9 10 11 12 13 14	Based on LPA Lee investigation 7 out of 10 residents has a concern in regards to staff not responding to resident’s call pendant in a timely manner. LPA Lee requested and reviewed 10 residents Personal Health Button Report (PHBR). The documents revealed that 3 residents (PHBR) were not responded within 15 minutes or less minutes per administrator, Luis and VIP of Operation, Terry. Furthermore, the documents also revealed that 7 residents (PHBR) stated that residents’ calls were ever respond to, which poses a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14	Administrator will also review regulations being cited today and write a statement of acknowledging that administrator along with facility staff are aware of the regulation being cited today. POC will be email to LPA Lee at pang.lee@dss.ca.gov by POC date 11/07/2023 by end of day 5:00 PM.
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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-Lee	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

LIC9099 (FAS) - (06/04)

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