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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701121
Report Date: 07/23/2024
Date Signed: 07/23/2024 03:00:00 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
05/20/2024 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240520110159
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:
08:30 PM
MET WITH:Kathleen GilbeyTIME COMPLETED:
10:30 PM
ALLEGATION(S):
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Staff does not respond to residents call pendant in a timely manner.
INVESTIGATION FINDINGS:
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On 07/23/2024 at 9:30, 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 finding for the allegation above. The current census is 135. A brief interview with conducted with the administrator.

Allegation: Staff does not respond to residents’ call pendant in a timely manner.
It was alleged that staff does not respond to resident(s) call pendant in a timely manner. This investigation consisted of records reviewed, interviews with staff and residents. LPA Lee interviewed 4 out of 9 residents who has concern regards to staff not responding to resident’s call pendant in a timely manner. LPA Lee requested and reviewed 8 residents SMART care log. It was learned that 7 out of 8 SMART care log resident’s alert was not responded; therefore, it is unclear if residents receive the support that residents needed.
Continued LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 508-9726
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-20240520110159
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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 It was also learned from Vice President of Operation, Terry Ervin that the facility response time is between 15 minutes or less. The documents revealed that 7 out of 8 residents SMART care log were not responded within 15 minutes or less minutes per Vice President of Operation, Terry. In addition multiple SMART care logs indicated that staff did not respond to residents until 30 minutes later.

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-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 508-9726
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: 3 of 5
Control Number 27-AS-20240520110159
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 B
08/02/2024
Section Cited
CCR
87303(i)(1)(B)
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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.
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The administrator will review SMART care log 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. Administrator will also review regulations being cited today and write a statement of acknowledging that
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This requirement was not met as evidence by:

Based on 7 out 8 resident SMART care log it was learned that residents alert call was not responded to and that occasionally calls took over 15 minutes to respond, which poses a potential health, safety, or personal rights risk to persons in care.
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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 08/02/2024 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-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 508-9726
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: 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
05/20/2024 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240520110159

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:
08:30 PM
MET WITH:Kathleen GilbeyTIME COMPLETED:
10:30 PM
ALLEGATION(S):
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Staff did not ensure resident's oxygen care needs were met in a timely manner.
INVESTIGATION FINDINGS:
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On 07/23/2024 at 9:30, 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 ensure resident's oxygen care needs were met in a timely manner.
It was alleged that staff did not ensure resident’s oxygen care needs were met in a timely manner. This investigation consisted of records reviewed and interviews with staff and residents. LPA Lee interviewed 6 out of 7 residents who are on oxygen and stated that they have no concerns with staff not ensuring that residents oxygen care needs are being met. LPA Lee also interviewed 5/5 facility staff who stated that residents who uses oxygen does get monitoring and assistance. It was learned that (R1) recently received a new motorized wheelchair and that (R1) needed staff assistance to ensure that (R1) had enough oxygen for the next day since (R1) had an appointment to attend to.
Continued LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 508-9726
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: 4 of 5
Control Number 27-AS-20240520110159
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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 It was also learned that (R1) needed assistance with staff helping (R1) carry the oxygen tank to put on (R1)’s new motorized wheelchair. Based on (R1)’s Physician Report (R1) is able to administer his/her own oxygen. Moreover, (R1)’s Resident’s Assessment dated on 04/30/2024, (R1) uses continuous oxygen and requires staff monitoring and assistance of an appropriately skilled professional. (R1)’s Individualized Service Plan (ISP) also states that (R1) needs assistance with (R1)’s portable oxygen tank and placing on (R1)’s electric scooter, every morning. (R1) also needs to have oxygen tank checked each evening in preparedness for the next day. Based on records reviewed, It was learned that on 05/18/2024 (R1)’s oxygen tank was check during the morning, noon and evening.

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.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 508-9726
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: 5 of 5