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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701014
Report Date: 07/27/2023
Date Signed: 07/27/2023 03:10:16 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
04/12/2023 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20230412133753
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: 90DATE:
07/27/2023
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Patricia Holguin, Executive DirectorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Facility is Malodorous
INVESTIGATION FINDINGS:
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On 07/27/2023, Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to the facility to complete an investigation and present the findings. LPA Campbell met with Patricia Holguin, Temporary Executive Director and Rachel David, Regional Health Services and stated the purpose of the visit.

When LPA Campbell visited the facility in 4/14/23, 05/18/23, 06/15/23 and 06/20/23 there were no fecal or other odors noted. However, during interviews, several staff members stated there was a “strong fecal odor” during the norovirus outbreak in April. Based on confirmation of the Administrator and staff that this allegation did occur, the above allegation(s) is found to be SUBSTANTIATED. A finding that the complaint allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are being cited on the attached 9099D during this visit. If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed. The Administrator was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights. An exit interview was conducted and a copy of this report was provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Emerita CurielTELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023
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 4
Control Number 27-AS-20230412133753
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/28/2023
Section Cited
CCR
87625(b)(3)
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Managed Incontinence. the licensee shall be responsible for... Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence.
This requirement was not met as evidenced by:
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Administrator will provide a letter of understanding along with a plan for future outbreaks that involve non-complaint residents by POC due date.
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Based on interviews, the facility has stated the facility was malodorous due to incontinence. The licensee did not ensure the facility remained odor free from incontinence and this impacted the 25 members of Memory Care. This poses a potential health and safety risk to residents in care.
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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: Emerita CurielTELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
04/12/2023 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20230412133753

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: 90DATE:
07/27/2023
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Patricia Holguin, Executive DirectorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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9
Staff failed to keep residents hydrated
Resident was left unattended
Staff failed to meet residents’ needs
INVESTIGATION FINDINGS:
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On 07/27/2023, Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to the facility to completed an investigation and present the findings. LPA Campbell met with Patricia Holguin, Temporary Executive Director and Rachel David, Regional Health Services, stated the purpose of the visit.

Regarding the allegations, "Staff failed to keep residents hydrated" the facility provided and supported residents in remaining hydrated. When residents did not drink, staff would "stay with the residents" until they drank the liquids provided. Per staff interviews, bottles of pedialyte, gatorade and water were made available. Staff reported that "Between checking in and staying with residents for hydration and checking back every 30 min" they constantly checked on residents who were ill for accidents or if they needed anything. In addition, the reporting party refused to answer any follow up questions as they would not provide contact information.

Therefore, the following allegations were found to be UNSUBSTANTIATED A finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. An exit interview was conducted, copy of report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Emerita CurielTELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
04/12/2023 and conducted by Evaluator Renee Campbell
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230412133753

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:
07/27/2023
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Patricia Holguin, Executive DirectorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff failed to meet reporting requirements
Facility has an outbreak of Celiac Disease
INVESTIGATION FINDINGS:
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On 07/27/2023, Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to the facility to complete an investigation and present the findings. LPA Campbell met with Patricia Holguin, Temporary Executive Director and stated the purpose of the visit.

Regarding the allegation, “Staff failed to meet reporting requirements”, Investigations revealed that the facility did follow reporting requirements. LPA reviewed the incident reports regarding the outbreak that the facility provided. The facility also sent follow up documentation to the Department of Health about the ongoing status of the affected clients. There was also an allegation that , “Facility has an outbreak of Celiac Disease”. Webmed defines celiac disease as “a disorder that’s triggered when you eat gluten.” And thus it is not contagious.

Based on the above mentioned information, the allegation is UNFOUNDED, meaning that the allegation was false, could not have happened and/or was without a reasonable basis. This Department has therefore dismissed the complaint. Per California Code of Regulations, no deficiencies were observed. Exit interview held, and a copy of the report was provided to licensee representative.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Emerita CurielTELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4