392700339-5-12-2021-27-AS-KHOS-C4WLQ2-20210714085648

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700339
Report Date: 04/27/2021
Date Signed: 05/12/2021 08:32:54 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
04/09/2021 and conducted by Evaluator Albert Johnson

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20210409114902

FACILITY NAME:	OAKMONT OF BROOKSIDE		FACILITY NUMBER:	392700339
ADMINISTRATOR:	HOLGUIN, PATRICIA (PATTY)		FACILITY TYPE:	740
ADDRESS:	3318 BROOKSIDE RD		TELEPHONE:	(209) 473-1300
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95219
CAPACITY:	81	CENSUS: 64	DATE:	04/27/2021
		UNANNOUNCED	TIME BEGAN:	01:42 PM
MET WITH:	P. Holguin		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility staff is not providing adequate activities for the residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to deliver findings into allegation listed above. LPA met with the Administrator during today's inspection.

Allegation: Facility staff is not providing adequate activities for the residents. Based on touring the facility, interviews with staff and observations, LPA Johnson was unable to establish that the facility staff is not providing adequate activities for the residents. The facility has added additional staff for the weekdays as well as the weekends to assist in the implementation of activities in accordance with the activities schedule.

The facility does not have an Activities Director for memory care at this time. The facility is in the process of hiring an Activities Director for the memory care, in the interim staff are providing on-going activities on the weekend as well as daily. (Continued on 9099C)

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert Johnson	TELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2021

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 27-AS-20210409114902

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 BROOKSIDE	FACILITY NUMBER: 392700339
	VISIT DATE: 04/27/2021

NARRATIVE

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During the tour of the facility today, LPA observed residents engaged in activities in the memory care area as well as on the assisted living side. The Department find this allegation to be Unsubstantiated.

A finding that a complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

An exit interview was conducted with the Administrator.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert Johnson	TELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2021

LIC9099 (FAS) - (06/04)

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