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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701014
Report Date: 08/18/2022
Date Signed: 08/18/2022 05:23:44 PM


Document Has Been Signed on 08/18/2022 05:23 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 LODIFACILITY NUMBER:
392701014
ADMINISTRATOR:PRYOR, JESSICAFACILITY TYPE:
740
ADDRESS:2905 REYNOLDS RANCH PARKWAYTELEPHONE:
(949) 744-5200
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:136CENSUS: 94DATE:
08/18/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Jessie Kelly and Denise DeCarieTIME COMPLETED:
03:45 PM
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On 8/18/22 at approximately 1:30pm, Licensing Program Analyst (LPA) Maja Jensen arrived unannounced at facility to conduct a quarterly visit. LPA Jensen met with Regional Memory Specialist Jessie Kelly and Business Office Manager Denise DeCarie and explained the purpose of today's visit. Denise DeCarie called Executive Sara Mackedsy by telephone and LPA Jensen also explained the purpose of today's visit to her.

On 5/24/22 an office meeting was held and some of the issues discussed included:
· Medication errors
· staffing shortages

LPA Jensen reviewed the Medication Administration Record for Resident 3 (R3). LPA Jensen also interviewed a medication nurse who verified the information on the MARs. Based on the interview with the medication nurse and the MARs entries, insulin was needed and not administered to R3 on June 17, 18 and August 15. as a result of not having a nurse on site. Regional Memory Specialist Jessie Kelly confirmed that R3 was present at the facility on those dates

LPA Jensen interviewed the responsible party (RP) of R1 in R1's room. While interviewing the RP Resident 2 mistakenly wandered in to the room and needed assistance. LPA Jensen pressed the alert button to summon staff at 2:43pm and again at 2:44pm. At 3:13pm LPA Jensen notified Regional Memory Care Specialist Jessie Kelly that there was no response to the alert button call.

Due to insufficient time the LPA will return at a later date to complete the quarterly visit.

An exit interview was conducted and a copy of this report was emailed to the executive director and Licensee.



SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:
DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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