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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701014
Report Date: 11/03/2022
Date Signed: 11/03/2022 02:09:16 PM

Unfounded


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
09/23/2022 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20220923095918
FACILITY NAME:OAKMONT OF LODIFACILITY NUMBER:
392701014
ADMINISTRATOR:SARA MACKEDSYFACILITY TYPE:
740
ADDRESS:2905 REYNOLDS RANCH PARKWAYTELEPHONE:
(949) 744-5200
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:136CENSUS: DATE:
11/03/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:TIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff is not providing resident with proper diet plan.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/3/22 at 11:00am Licensing Program Anlayst (LPA) Maja Jensen arrived at facility unannounced to continue a complaint investigation in to the above listed allegation.

LPA Jensen reviewed the file for resident 1 (R1) and determined that the resident did not have a a restricted diet plan ordered by a medical provider prior to the date of the complaint was initiated. LPA Jensen determined based on records and and an interview with Executive Director Sara Mackedsy that R1 was placed on a restricted diet as of 9/23/22. As there was no physician ordered diet plan in place prior to the intake of this complaint, the allegation has been determined to be UNFOUNDED. A determination of unfounded means that the allegation is false, could not have happened, or is without a reasonable basis.

No deficiencies were issued as a result of this visit. An exit interview was conducted and a copy of this report was given to Executive Director Sara Mackedsy.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
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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