374603792-7-1-2021-08-AS-SJAB-C5EVED-20210730162209

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603792
Report Date: 06/30/2021
Date Signed: 07/01/2021 11:27:03 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/26/2020 and conducted by Evaluator Daniel Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20200226131518

FACILITY NAME:	OAKMONT OF PACIFIC BEACH		FACILITY NUMBER:	374603792
ADMINISTRATOR:	ROXANNE GOODING		FACILITY TYPE:	740
ADDRESS:	955 GRAND AVE		TELEPHONE:	(858) 373-9300
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92109
CAPACITY:	0	CENSUS: 0	DATE:	06/30/2021
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Sent Via Certified Mail to Last Known Address		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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-Staff left resident in soiled clothing
-Staff did not inform resident's authorized rep of incidents involving resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Daniel Pena sent this report to the former licensee's last known mailing address via USPS certified mail, to deliver the investigation findings for the above allegation. This facility ceased operations on July 14, 2020.

It was alleged that staff left Resident 1 (LIC811 Confidential Names was provided to identify R1) in soiled clothing. A review of R1 records revealed a history of inappropriate toileting and/or toileting in inappropriate places. R1 required a schedule for toileting and assistance to and from the bathroom; assistance with incontinence supplies, hygiene, and/or changing linen. Staff interviews indicated memory care unit residents are changed at least every two hours and more if needed. Interviews with independent outside sources revealed no concerns or lapses of incontinence care to other residents. Based on this allegation, the facility has implemented a daily log to document incontinence checks and changes.

It was also alleged that staff did not inform R1’s authorized representative of incidents involving the resident. Interviews conducted and a records review revealed that the

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Girolami	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021

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 08-AS-20200226131518

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: OAKMONT OF PACIFIC BEACH	FACILITY NUMBER: 374603792
	VISIT DATE: 06/30/2021

NARRATIVE

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facility has reported incidents to the department and authorized representative as they occurred. Evidence obtained depicted reports and resident care notes which described an incident that occurred involving R1. Both documents indicated that the responsible party was notified.

Based on interviews conducted and pertinent records reviewed, it was determined although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. The allegations are determined to be Unsubstantiated.

A copy of this report and appeals rights (LIC 9058 1/16) were sent to the licensee's last known address via USPS certified mail due to facility closure.

SUPERVISOR'S NAME: Tony Girolami	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021

LIC9099 (FAS) - (06/04)

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