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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701121
Report Date: 07/23/2024
Date Signed: 08/23/2024 08:56:16 AM

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
04/19/2024 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240419093805
FACILITY NAME:OAKMONT OF EAST SACRAMENTOFACILITY NUMBER:
342701121
ADMINISTRATOR:KATHLEEN GILBEYFACILITY TYPE:
740
ADDRESS:5301 F STREETTELEPHONE:
(916) 905-2400
CITY:EAST SACRAMENTOSTATE: CAZIP CODE:
95819
CAPACITY:214CENSUS: 135DATE:
07/23/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Juliann OwensTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
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9
Staff did not safeguard resident’s personal belongings
INVESTIGATION FINDINGS:
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9
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13
THIS IS AN AMENDED VERSION OF THE ORIGINAL REPORT CREATED ON 07/23/2024.

On 07/23/2024 at 10:30 AM, Licensing Program Analysts (LPAs) Pang Lee and Holly Williams arrived unannounced to this facility to conduct a complaint visit. LPA met with Assistant Executive Juliann Owens 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 135. A brief interview with conducted with the Juliann

Allegation: Staff did not safeguard resident’s personal belongings
It was alleged that staff did not safeguard resident’s personal belongings. This investigation consisted of records reviewed and interviews with staff. It was learned that resident 1 (R1) did not want to inventory personal property. On 04/24/2024 administrator Kathleen Gilbey stated that (R1)’s glasses were safeguarded since it was not lost but were in (R1)’s room and that a facility staff notice that (R1)’s glasses were broken; therefore, the facility staff threw (R1)’s glasses away without informing (R1) and (R1)’s Power of Attorney (POA).

Continued LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
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-20240419093805
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: 07/23/2024
NARRATIVE
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THIS IS AN AMENDED VERSION OF THE ORIGINAL REPORT DATED ON 07/23/2024.

It is unclear how (R1)’s glasses were broken based on interviews. It was also learned that (R1)’s hearing aid was lost at the hospital when (R1) was admitted to the hospital. It is unclear to who lost (R1)’s hearing aid. On 04/26/2024 it was learned that the facility gave (R1) a reimbursement of $400 for (R1)’s glasses.

The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegation is UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 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
04/19/2024 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240419093805

FACILITY NAME:OAKMONT OF EAST SACRAMENTOFACILITY NUMBER:
342701121
ADMINISTRATOR:KATHLEEN GILBEYFACILITY TYPE:
740
ADDRESS:5301 F STREETTELEPHONE:
(916) 905-2400
CITY:EAST SACRAMENTOSTATE: CAZIP CODE:
95819
CAPACITY:214CENSUS: 135DATE:
07/23/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Kathleen GilbeyTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not assist resident with feeding
Staff did not meet resident's needs
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 07/23/2024 at 8:30 AM, Licensing Program Analysts (LPAs) Pang Lee and Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA met with administrator Kathleen Gilbey and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 135. A brief interview with conducted with the administrator.

Allegation: Staff did not assist resident with feeding and Staff did not meet resident's needs
It was alleged that staff did not assist resident with feeding and staff did not meet resident’s needs. This investigation consisted of records reviewed and interviews with staff and residents. LPA Lee interviewed 9 out of 9 residents who have no concern with staff not assisting residents with feeding and with resident’s needs. 5 out of 5 staff denied the allegations. It was learned that resident 1 (R1) can choose to come out for (R1)’s meals or have it delivered to (R1)’s room. Based on (R1)’s Individualized Service Plan (ISP) and Resident Assessment (R1) does not required assistance with feeding and that (R1) will eat independently.
Continued LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20240419093805
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: 07/23/2024
NARRATIVE
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 Moreover, (R1)’s LIC 602 Physician’s Report also indicate that (R1) is able to feed herself/himself. Based on (R1) charting notes, it was also learned that (R1) comes out to the dining room to eat her/his meal.
The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20240419093805
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: 07/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
CCR
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7

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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.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5