366426338-9-16-2022-18-AS-EMAN-CKDTF9-20221020144108

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366426338
Report Date: 09/16/2022
Date Signed: 09/16/2022 11:30:01 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/07/2021 and conducted by Evaluator Natalie Ibarra

COMPLAINT CONTROL NUMBER: 18-AS-20210107141618

FACILITY NAME:	OAKMONT OF SAN ANTONIO HEIGHTS		FACILITY NUMBER:	366426338
ADMINISTRATOR:	ERIKA LEMON		FACILITY TYPE:	740
ADDRESS:	2419 N EUCLID AVE		TELEPHONE:	(909) 981-4002
CITY:	UPLAND	STATE: CA	ZIP CODE:	91786
CAPACITY:	140	CENSUS:	DATE:	09/16/2022
		UNANNOUNCED	TIME BEGAN:	11:19 AM
MET WITH:	Samuel de Guzman		TIME COMPLETED:	11:37 AM

ALLEGATION(S):

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Staff do not ensure that resident's special dietary needs are met

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Natalie Gayoso Ibarra conducted an unannounced visit to deliver findings for the above allegation. LPA met with administrator Samuel de Guzman and explained the purpose of today’s visit. The investigation consisted of interviews with pertinent parties and records review.

The allegation indicates staff do not ensure that resident's special dietary needs are met. Interviews with Staff #2 (S2) and Staff #3 (S3) stated the facility does meet the needs of residents who have special diets. S3 stated that kitchen staff have a list of residents who have special diets and do follow it. Caregivers also have a meal book that has information as to which residents comes out to eat meals, who refuses meals, who is on special diets, on mechanical puree diet, etc. Interviews with Resident #1 (R1), Resident #2 (R2), Resident #3 (R3), and Resident #4 (R4) indicated they are diabetic but are not on any special diet per doctor orders. Residents know what they can and can not eat. R2, R3, and R4 stated the facility does have many options that they can choose from if they can not eat what is being served.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Natalie Ibarra	TELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2022

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 18-AS-20210107141618

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: OAKMONT OF SAN ANTONIO HEIGHTS	FACILITY NUMBER: 366426338
	VISIT DATE: 09/16/2022

NARRATIVE

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R4 stated the facility does provide deserts that are sugar free. LPA reviewed copies of facility menu and observed there are additional options for residents to choose from.

Based on interviews and records review, the allegation is UNSUBSTANTIATED. A finding of Unsubstantiated means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

An exit interview was conducted, and a copy of this report was provided to administrator Samuel de Guzman.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Natalie Ibarra	TELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2022

LIC9099 (FAS) - (06/04)

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