392701014-7-21-2022-27-AS-KHOS-CGPRAK-20220726125117

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392701014
Report Date: 07/21/2022
Date Signed: 07/21/2022 03:49:17 PM

Unsubstantiated

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
04/21/2022 and conducted by Evaluator Treana White

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20220421122744

FACILITY NAME:	OAKMONT OF LODI		FACILITY NUMBER:	392701014
ADMINISTRATOR:	PRYOR, JESSICA		FACILITY TYPE:	740
ADDRESS:	2905 REYNOLDS RANCH PARKWAY		TELEPHONE:	(949) 744-5200
CITY:	LODI	STATE: CA	ZIP CODE:	95240
CAPACITY:	136	CENSUS: 96	DATE:	07/21/2022
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Patrick Olvera, Regional Memory Care Specialist		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Licensee does not allow resident to refuse Medical Care (Medications)

INVESTIGATION FINDINGS:

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On 07/21/2022 at 2:00 PM Licensing Program Analyst (LPA) T. White arrived at facility unannounced to open a complaint investigation related to the above allegation. LPA met with Virginia Alvarez, Health Service Director and Patrick Olvera, Regional Memory Care Specialist and explained the purpose of today's visit.

During course of investigation, interviewed 3 staff members and collected documentation. Based on 3 of 3 staff interviews, Resident #1 (R1) Power of Attorney (POA) did not want R1 taking certain medications. Based on documentation dated 04/22/2022, the facility requested R1 medication be discontinued due to family stating medication list is 5 years outdated. R1 family stated R1 is not on any medications. On 05/05/2022, R1’s Physician stated he will not sign any medication records since R1 is also under care of other doctors at the facility.

Report continues on 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Treana White	TELEPHONE: (510) 566-9342
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022

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 27-AS-20220421122744

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 LODI	FACILITY NUMBER: 392701014
	VISIT DATE: 07/21/2022

NARRATIVE

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Based on MAR’s and staff notes, R1 was not taking medication, due to no supply in the facility. 3 of 3 staff stated they were following what was on R1’s Physician’s Report, however R1’s POA did not provide the medication to administer medication Based on information provided on 07/20/2022, R1’s physician was able to discontinue R1’s medications. Staff no longer administer medications to R1 as of 06/22/2022. LPA is unable to prove or disprove if allegation did or did not occur.

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.

Exit interview conducted with Health Service Director and Regional Memory Care Specialist. A copy of report given.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Treana White	TELEPHONE: (510) 566-9342
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022

LIC9099 (FAS) - (06/04)

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