<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701014
Report Date: 09/09/2022
Date Signed: 09/09/2022 05:49:57 PM

Substantiated


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
09/02/2022 and conducted by Evaluator Michael Bilger
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20220902151731
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: 103DATE:
09/09/2022
UNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Sara MackedsyTIME COMPLETED:
12:51 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure the facility was free from bed bugs
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 9-9-22 at 9:55am, Licensing Program Analyst (LPA) Michael Bilger arrived at facility unannounced to open and investigate the complaint allegation noted above. LPA met with Administrator Sara Mackedsy and explained the purpose of the visit. During this investigation LPA interviewed Administrator and reviewed pest control service records. Based on record reviews and interviews, it was determined that facility experienced an episode of bed bug infestation in June of 2022. After this occurrence, facility initiated a specific bed bug treatment with pest control on 6-2-22 and 6-3-22. It was further determined that on 8-18-22, bed bugs were discovered by facility staff and bed bug treatment was initiated on 8-19-22. An additional episode of bed bugs discovered by facility staff occurred on 8-27-22 and bed bug treatment was initiated on 9-1-22.

During today’s visit, LPA observed pest control service onsite performing bed bug treatment. Based on interviews and record reviews, facility has a history of bed bug infestation beginning in June 2022, and a routine bed bug treatment service has not been initiated to properly to ensure preventative on-going measures.

{Cont. on 9099C}


Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 27-AS-20220902151731
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: 09/09/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
As a result of this investigation, the preponderance of evidence standard is met, and this allegation is SUBSTATIATED. Citation is issued today under Title 22, Division 6, Chapter 8. An exit interview was conducted with Sara Mackedsy and a copy of this report was left with Sara. Appeal rights provided.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20220902151731
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/19/2022
Section Cited
CCR
87303(a)
1
2
3
4
5
6
7
Maintenance and Operation. (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee will ensure routine pest control service specific to bed bug prevention be initiated. Copy of updated service agreement reflecting said service to be submitted to LPA by POC due date.
8
9
10
11
12
13
14
Based on record reviews and interviews, Licensee did not ensure a routine bed bug treatment service after an initial bed bug occurrence in June 2022. Additional bed bug episodes occurred on 8-18-22 and 8-27-22. This poses a potential health and safety risk to residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3