347005426-9-14-2020-27-AS-APEZ-BTHQ7R-20200916115530

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005426
Report Date: 09/14/2020
Date Signed: 09/14/2020 11:39:42 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/21/2020 and conducted by Evaluator Kevin Gasendo

COMPLAINT CONTROL NUMBER: 27-AS-20200721162055

FACILITY NAME:	OAKMONT OF CARMICHAEL		FACILITY NUMBER:	347005426
ADMINISTRATOR:	NATHAN CONDIE		FACILITY TYPE:	740
ADDRESS:	4717 ENGLE RD		TELEPHONE:	(916) 483-3800
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	101	CENSUS: 71	DATE:	09/14/2020
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Nathan Condie		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff did not provide resident privacy when resident and durable power of attorney spoke to doctor

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kevin Gasendo contacted Administrator Nathan Condie to deliver complaint findings for the allegation that staff did not provide a resident (R1) privacy when he and his power of attorney (POA) visited R1's physician for an appointment.

In July 2020, Wendy Harris (WH), Director of Health Services at the facility, observed that R1 had a change in his condition, having been "more confused and had vision problems", and that R1 would "walk a short distance and is confused because he can't see" and then would fall.

WH decided to call R1's physician and set an examination appointment. (Continued on 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kevin Gasendo	TELEPHONE: (209) 242-5200
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2020

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 3

Control Number 27-AS-20200721162055

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: OAKMONT OF CARMICHAEL	FACILITY NUMBER: 347005426
	VISIT DATE: 09/14/2020

NARRATIVE

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WH stated that she called R1's POA, who agreed to the appointment and met her and R1 at R1's physician's office. WH reported that POA drove in from out of town, and that POA comes to visit R1 infrequently, perhaps twice a month. R1, POA, and WH all physically went into the appointment with R1's physician.

LPA Gasendo called R1's physician, who confirmed that there was no unusual behavior or ill will exhibited by any of the parties during the examination. R1's physician said that POA did not ask for WH to stay out of the examination room at any point during the visit, and did not think it to be unusual for WH to be there since she was a nurse who gave care to R1 and would benefit from knowing details about his condition.

After the examination, POA reported to County Ombudsman that he was upset about WH being at the appointment and expressed his belief that WH had violated HIPPA laws by being in the examination room.

LPA Gasendo called R1's physician, who said that he does not have any formal policy regarding visitors but that he does ask patients if they want to have visitors.

R1's physician stated that R1 has severe dementia, and would not be able to make judgment on whether to bring a visitor or not. R1's physician said the next person he would ask would be the power of attorney or conservator. R1's physician states that "nothing unusual" happened at all during the appointment, and was "really surprised" to hear that the POA filed a complaint. R1's physician stated that if the POA had a problem with WH being there "he could have told me not to have her there" and he would not have allowed her to join.

LPA Gasendo attempted to call POA multiple times and left voice messages. POA did not respond to the inquiry. (Continued on 9099-C).

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kevin Gasendo	TELEPHONE: (209) 242-5200
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20200721162055

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: OAKMONT OF CARMICHAEL	FACILITY NUMBER: 347005426
	VISIT DATE: 09/14/2020

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Based on the above, the allegation cannot be proved or disproved, and therefore is Unsubstantiated. LPA signed the electronic copy. LPA is going to e-mail a copy of this report to Licensee. Licensee is to print, review, sign and e-mail a signed copy back to LPA.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kevin Gasendo	TELEPHONE: (209) 242-5200
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2020

LIC9099 (FAS) - (06/04)

Page: 3 of 3