366426338-7-27-2023-56-AS-EMAN-CUYQER-20230823120642

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366426338
Report Date: 07/27/2023
Date Signed: 07/27/2023 11:24:17 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
07/24/2023 and conducted by Evaluator Paola Guerrero

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230724104639

FACILITY NAME:	OAKMONT OF SAN ANTONIO HEIGHTS		FACILITY NUMBER:	366426338
ADMINISTRATOR:	SAMUEL DE GUZMAN		FACILITY TYPE:	740
ADDRESS:	2419 N EUCLID AVE		TELEPHONE:	(909) 981-4002
CITY:	UPLAND	STATE: CA	ZIP CODE:	91786
CAPACITY:	140	CENSUS: 81	DATE:	07/27/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Brandy Herrera		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff does not ensure that the facility has the electricity on.
Staff does not follow safe food handling practices.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to initiate and deliver the findings for the above allegations. LPA met with Facility Health Service Director Brandy Herrera who was informed of the purpose of my visit and the allegations listed above. The investigation consists of direct observations, records review, and interviews regarding the above allegations.

First Allegation: Staff does not ensure that the facility has the electricity on.

Regarding the first allegation, staff does not ensure that the facility has the electricity on. LPA conducted interviews with Resident #4 (R4), Resident #5 (R5), and Resident #6 (R6) who stated that almost a week ago facility had a power outtage. Resident #4 (R4) stated that power outtage was not due to a facility doing but rather a Southern California Edison (SCE) issue. LPA spoke to Health Services Director who stated that on 7/22/2023 at 4:15 PM facilty experienced a power outtage, Service Director stated that at 5:30 PM power came back on.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Paola Guerrero	TELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

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 56-AS-20230724104639

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: 07/27/2023

NARRATIVE

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Second Allegation: Staff does not follow safe food handling practices.

Regarding the second allegation, staff does not follow safe food handling practices. LPA conducted a kitchen inspection and observed refrigerator/and freezer to be set on the temperatures according to CCL regulations. Kitchen Manager stated that no complaints or recent food poisonings have been reported. Kitchen Manager stated that any food that has been sitting out for two (2) hours or any food that is out of temperature gets tossed. LPA interviewed Resident #1-6 whom all stated that they have no concerns with the food being served or issues with getting sick with the food at the facility. Based on the evidence obtained during the course of the investigation, LPA has determined that the above allegations are UNSUBSTANTIATED.

Unsubstantiated: meaning that 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.

An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Health Service Director Brandy Herrera at the end of the visit.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Paola Guerrero	TELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

LIC9099 (FAS) - (06/04)

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