392701014-7-13-2023-27-AS-KLES-CTPRU4-20230713131915

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 392701014
Report Date: 06/12/2023
Date Signed: 07/13/2023 01:24:44 PM

Document Has Been Signed on 07/13/2023 01:24 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
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME:	OAKMONT OF LODI		FACILITY NUMBER:	392701014
ADMINISTRATOR:	SARA MACKEDSY		FACILITY TYPE:	740
ADDRESS:	2905 REYNOLDS RANCH PARKWAY		TELEPHONE:	(949) 744-5200
CITY:	LODI	STATE: CA	ZIP CODE:	95240
CAPACITY:	136	CENSUS:	DATE:	06/12/2023
TYPE OF VISIT:	Case Management - Legal/Non-compliance	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Facility Representatives		TIME COMPLETED:	12:00 PM

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	A Non-Compliance Conference (NCC) was conducted on this day, 06122023, by the Sacramento South Regional Office via Teams meeting. This Noncompliance Conference was called to discuss the following issues or deficiencies: Care and Supervision, Incidental Medical Care, Personal Rights, Maintenance and Operation, Managed Incontinence Present in the meeting was Regional Manager (RM), Stephenie Doub, Licensing Program Manager (LPM), Liza King, (LPM) Camilon-Lee, Czarrina Licensing Program Analyst (LPA) Kesha Lewis and Renee Campbell, Tamara Fernandez, Senior VP of Operations, Christy Merritt, VP of Operations, Melissa Solomon, Senior VP of Legal, Sue McPherson, Senior VP of Regulatory, Jen Sato, Vice President of Health Services, Rachel David, Regional Director of Health Services, Interim Administrator Eugenia Smith and Joel Goldman, Partner at Hanson Bridgett. The Non-Compliance Conference process was explained during this meeting to include the Administrative Process. RM, LPM and LPAs discussed the following citations and the associated plans of correction going forward. Please note some citations may are under appeal at this time:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Kesha Lewis	TELEPHONE: (650) 676-0552
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: OAKMONT OF LODI	FACILITY NUMBER: 392701014
	VISIT DATE: 06/12/2023

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

Issues discussed during the meeting were citations issued since the Informal Meeting Jan 2023: :
· On 5-18-23 a citation was issued under Health and Safety Code (HSC) 1569.312(a) Basic Service Requirements after a completed investigation by the Department on a questionable death related to a resident falling and sustaining a head injury.
· On 5-18-23 a citation was issued under Section 87211(a)(1)(D) Reporting Requirements due to multiple falls of a resident over a four-month period not reported to licensing per regulatory requirements.
· On 5-18-23 a citation was issued under Section 87405(h)(5) Administrator Qualifications due to failure to implement a sufficient provision to aid in fall prevention after a resident sustained multiple falls over a four-month period.
· On 1-26-23 a citation was issued under Section 87625(a)(1)(A)(B)(C)(D) Managed Incontinence due to absence of a documented regulatory required managed incontinence care plan for a resident in care. This citation is currently under appeal.
· On 1-26-23 a citation was issued under Section 87468.1(a)(2) Personal Rights due to facility unable to ensure a comfortable temperature in a resident’s room after a malfunction of resident’s heating unit occurred. This citation is currently under appeal.
· On 1-26-23 a citation was issued under Section 87303(a) Maintenance and Operation due to a malfunctioning heating unit between 12-15-22 and 12-18-22. This citation is currently under appeal.
· On 1-26-23 a citation was issued under Section 87465(a)(4) Incidental Medical and Dental Care due to licensee not ensuring a necessary follow up to a medication order discrepancy. This citation is currently under appeal.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Kesha Lewis	TELEPHONE: (650) 676-0552
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023

LIC809 (FAS) - (06/04)

Page: 5 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: OAKMONT OF LODI	FACILITY NUMBER: 392701014
	VISIT DATE: 06/12/2023

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

During the meeting on 6/12/2023, the facility agreed to the following:
1. Presence of Administrator present at least 40 hours per week,

2. A documented plan to ensure all incidents are reported as appropriate and timely, including

· The Senior Vice President of Operations will conduct an in-service with community leadership on reporting requirements by 06/16/2023.

· Ongoing weekly Compliance focus call with regional leadership to review each week's incidents, inspect reporting compliance, and ensure proper interventions and follow-ups are in place until further notice.

3. A fall prevention plan going forward to identify fall risk residents and appropriate interventions, including:

· ongoing assessment and interventions documented on the residents care plan, including assessment by contracted on site Rehab

· ongoing Fall Intervention Training for all team members quarterly, all teams members will have training completed by 06/30/2023,

4. Continue memory care family support group though one on ones with family members

5. Continue town hall via zoom or in person meetings with families monthly, also a family news letter goes out monthly to family.

Going forward, the Vice President of Operations will join these town halls to provide corporate corporate oversight and ensure actions are taken to address any ongoing concerns or issues.

6. Continue monthly resident town halls

Going forward, the Vice President of Operations will join these town halls to provide corporate oversight and ensure actions are taken to address any ongoing concerns or issues.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Kesha Lewis	TELEPHONE: (650) 676-0552
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: OAKMONT OF LODI	FACILITY NUMBER: 392701014
	VISIT DATE: 06/12/2023

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

7. A monthly family newsletter will be sent out to all memory care families and assisted living to keep them engaged and informed about community events and updates.

8. On-going Checklist to ensure proper maintenance of facility

9. On-going maintenance of a managed incontinence care plan for residents in care

10. On-going plan on how medications are handled which includes ensuring physician's orders are present prior to assisting with self-administration of medications.

11. Management to continue weekly unannounced NOC shift visits

12. In addition, the Licensee will ensure Administrative Oversight to include:

· Oakmont will establish a compliance visit schedule to ensure a member of our regional team visits this community weekly until further notice.

· Skip Level meetings will be conducted on a quarterly basis with both department leadership and front-line team members and residents.

· We will have a weekly Compliance focus call with regional leadership to review each week's incidents, inspect reporting compliance, and ensure proper interventions and follow-ups are in place until further notice.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Kesha Lewis	TELEPHONE: (650) 676-0552
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023

LIC809 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: OAKMONT OF LODI	FACILITY NUMBER: 392701014
	VISIT DATE: 06/12/2023

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

Community Care Licensing Department (CCLD) will do the following:

Increased monitoring.

In the event that the Department determines that the licensee has violated the law/regulations or is inadequately implementing the approved plans, the Department, in its discretion, may seek formal legal action or other appropriate administrative action.

Completing the Non-Compliance Conference does not deprive the Department of its authority to take appropriate formal legal action under the Health and Safety Code if such action is deemed necessary by the Regional Manager.

Per California Code of Regulations (CCRs) - Title 22 no deficiencies are being cited during this visit. An exit interview was conducted and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documen

ts.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Kesha Lewis	TELEPHONE: (650) 676-0552
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023

LIC809 (FAS) - (06/04)

Page: 2 of 5