345002797-9-1-2026-59-AS-LCRR-DYEVAH-20260930161553

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345002797
Report Date: 09/01/2026
Date Signed: 09/01/2026 06:46:34 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
04/03/2026 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20260403150731

FACILITY NAME:	OAKMONT OF FAIR OAKS		FACILITY NUMBER:	345002797
ADMINISTRATOR:	POUYA ANSARI		FACILITY TYPE:	740
ADDRESS:	8484 MADISON AVE.		TELEPHONE:	(916) 633-1001
CITY:	FAIR OAKS	STATE: CA	ZIP CODE:	95628
CAPACITY:	128	CENSUS: 85	DATE:	09/01/2026
		UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Anyssa Hill, Administrator and Alexa Memory Care Director		TIME COMPLETED:	06:45 PM

ALLEGATION(S):

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Facility staff are not observing the residents for changes in condition.
Facility staff are not following doctor’s orders.
Facility staff are not sufficiently trained.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to complete the investigation and deliver partial findings to a complaint received on April 3, 2026. LPA met with Anyssa Hill, Administrator and Alexis Mendoza, Memory Care Director. LPA stated the reason for today's inspection.

During the investigation, LPA interviewed multiple faciility staff from all shifts, managers, resident (R1), and a family member of (R1). LPA reviewed related documentation, including (R1's) Physician's Report, care plan, oxygen orders, Medication Administration Record (May 2026), and other documentation. The results of the investigation are as follows:

Resident (R1) moved to the Memory Care side of the facility in 2023. (R1's) Physician's report (6/14/2024) notes (R1) has a diagnosis of Lower GI Hemorrhage, Diverticulitis, Dementia, Atrial Fibrillation and has auditory/visual impairments, bowel/bladder incontinence, is able to communicate/follow instructions, and needs assistance with all Activities of Daily Living (ADL's) but feeding.
*cont on 9099C-1..

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026

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 59-AS-20260403150731

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: OAKMONT OF FAIR OAKS	FACILITY NUMBER: 345002797
	VISIT DATE: 09/01/2026

NARRATIVE

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9099C-1.. (R1's) care plan was updated on March 17, 2026, due to a change in condition. This care plan notes (R1) needs assistance with hearing aids, requires assistance with toileting, can walk to/from dining room and to all activities within the facility, is on a fall management program, and uses a walker.

Allegation: Facility staff are not observing the residents for changes in condition. The allegation states on the morning of April 2, 2026, around 9AM, a caregiver helped (R1) call a family member and said the hallucinations would go away" and did not appear to be trained to handle this type of situation.

The family member stated she noticed that (R1) was "off" and thought is was just her vision giving her trouble.

Multiple staff interviews revealed that on occasion, (R1) will have hallucinations and see things in their room that are not there. Staff indicated they have observed (R1) to be hallucinating for one to two hours during the day, or during the night. One caregiver staff indicated that staff have had training to handle resident hallucinations and will tell (R1), "to calm down, you'll be fine and it's a dream and it's not real" and commented that (R1) has a "very sweet temperament". Another care staff stated, , "Yes, I have seen (R1) hallucinating- with or without a UTI- sometimes (R1) is confused" and might say, "there are kids over there making noise." This staff stated, "I meet (R1) where she is at".

LPA reviewed training records for (13) staff. All staff have recently (2026) taken regular required training on different topics related to providing care to individuals with Dementia. All training was completed through an approved Department vendor. Additionally, staff participate in monthly In-Service trainings provided by facility managers on various topics related to resident care.

Based on information obtained, the allegation is found to be UNSUBSTANTIATED- A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

*cont on 9099C-2..

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 59-AS-20260403150731

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: OAKMONT OF FAIR OAKS	FACILITY NUMBER: 345002797
	VISIT DATE: 09/01/2026

NARRATIVE

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9099C-2.. Allegation: Facility staff are not following doctor’s orders. The allegation states (R1) was sent to the hospital on March 31, 2026, diagnosed with a Urinary Tract Infection (UTI) and released on April 2, 2026 with orders for Home Health to start. The family stated (R1's) resident's O2 will drop unexpectedly and requires breathing treatments every four (4) hours while awake by Med-Techs but may not be receiving them.

The Medication Administration Record (MAR) for May 2026 was provided to LPA on May 7, 2026. This MAR lists Abuterol treatments to be given every (4) hours, during waking hours for shortness of breath. The May MAR shows treatments were administered at 8:00 am, 12:00 pm, 4:00 pm and at 8:00 pm on May 1- 3, 2026 and then at 8:00 am on May 4, 2026. The 12:-00 pm dose was not administered on May 4, 2026 due to resident being out of the facility, but was resumed at 4:00 pm and 8:00 pm. On May 5, 2026, the MAR notes that (4) doses were administered, per orders, on May 5 and 6, 2026.

The care plan (dated March 17, 2026) states "Resident does not require breathing treatments". The complaint was received on April 3, 2026. Based on the May MAR 2026, the order for Albuterol was entered on November 5, 2025, and (R1) should have been receiving them. The April 2026 MAR was not available when providing findings, but will be available this week.

Based on information obtained, the allegation is found to be UNSUBSTANTIATED- A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened

cont on 9099C-3..

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 59-AS-20260403150731

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: OAKMONT OF FAIR OAKS	FACILITY NUMBER: 345002797
	VISIT DATE: 09/01/2026

NARRATIVE

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9099C-3.. Allegation: Facility staff are not sufficiently trained.The allegation states that staff are not trained in working with Dementia residents who use oxygen 24/7, or have a Urinary Tract Infection (UTI).

One staff stated "We had different trainings- hospice and home health and In-Services trainings- I'm not sure of the frequency". Another staff stated that Med-Techs may be the only staff who receive training on oxygen.
LPA reviewed training records for (13) staff. All staff have recently (2026) taken regular required training on different topics related to providing care to individuals with Dementia. All training was completed through an approved Department vendor.

Additionally, In-Service training was provided by the Administrator on Hospice in January 2026 and in May 2026. Additional monthly In-Service trainings were completed in February, March and April 2026 with the topics of: Dementia, lifting, ADL’s, elopements, care with dignity.

The current Administrator stated that all staff are provided with continued training and outside hospice companies will provide training specific to hospice residents.

Based on information obtained, the allegation is found to be UNSUBSTANTIATED- A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview. Copy of report provided.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026

LIC9099 (FAS) - (06/04)

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