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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701014
Report Date: 01/26/2023
Date Signed: 01/26/2023 05:13:41 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
12/19/2022 and conducted by Evaluator Michael Bilger
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20221219095046
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: 88DATE:
01/26/2023
UNANNOUNCEDTIME BEGAN:
02:14 PM
MET WITH:Sara MackedsyTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Facility staff does not ensure that resident's room is at a comfortable temperature.
Facility is in disrepair.
INVESTIGATION FINDINGS:
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On 1-26-23 at 2:14pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver complaint findings for the allegations listed above. LPA met with Administrator Sara Mackedsy and explained the purpose of the visit. During this investigation LPA conducted interviews with Administrator, Staff1 (S1), S2, and S3. LPA also conducted a facility observation on 12-30-22. Additionally, LPA reviewed work orders for facility’s heating unit, and additional email communication submitted by facility.
Allegation #1: Facility staff does not ensure that resident’s room is at a comfortable temperature. LPA interviewed Administrator, S1, S2, and S3. LPA also reviewed work order for heating unit. Based on interviews conducted, it was determined that room #133 in which R1 resided was not producing heat between the dates of 12-15-22 and 12-18-22, with repair completed on 12-18-22. LPA observed heating unit to be operating as normal on 12-30-22 during facility visit and observation.
{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: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
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 5
Control Number 27-AS-20221219095046
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: 01/26/2023
NARRATIVE
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Based on interviews, it was also determined that facility staff had knowledge of heating unit not producing heat on 12-15-22, but message was not reached by management staff until the evening of 12-16-22 based on work order; prompting follow up on 12-17-22, and eventual repair on 12-18-22. As a result, there is a preponderance of evidence to conclude facility had knowledge of malfunctioning heating unit, but did not act timely to ensure a comfortable temperature remained in R1’s room from 12-15-22 until completed repair. As a result this allegation is SUBSTANTIATED.

Allegation #2: Facility is in disrepair. LPA interviewed Administrator, S1, S2, and S3. LPA also conducted facility observation on 12-30-22. Based on interviews conducted, it was determined that room #133 in which R1 resided was not producing heat between the dates of 12-15-22 and 12-18-22, with repair completed on 12-18-22. It was further determined that facility staff had knowledge of malfunctioning heating unit on 12-15-22, with message not reaching management staff until 12-16-22 as noted on reviewed work order dated 12-17-22. Heating unit was repaired on 12-18-22. Based on the interviews conducted and records reviewed, there is a preponderance of evidence to conclude that facility’s heating unit in room #133 was in need of repair on 12-15-22 with follow up occurring on 12-17-22. As a result, this allegation is SUBSTANTIATED.

Based on this investigation, citations are issued under Title 22, Division 6 and noted on LIC 9099D. A civil penalty was issued in addition to the citation due to repeat violation within a 12-month period. 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: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20221219095046
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: 01/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
02/24/2023
Section Cited
CCR
87468.1(a)(2)
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87468.1(a)(2) Personal rights of residents in all facilities. (a)Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by:
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Licensee will submit a plan ensuring how resident needs will be met in the event of needed repairs. Plan to be submitted to LPA by POC due date.
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Based on interview and record review, facility’s heating unit in R1’s room was malfunctioning on 12-15-22 and not repaired until 12-18-22 which did not ensure a comfortable temperature in R1’s room.. This posed a potential health, safety, and resident rights risk to resident in care.
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Request Denied
Type B
02/24/2023
Section Cited
CCR
87303(a)
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87303(a) Maintenance and Operation. (a) The facility shall be clean, safe, sanitary and in good repair at all times…This requirement was not met as evidenced by:
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Licensee has since repaired heating unit to appropriate functional status.
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Based on interview and record review, facility staff had knowledge of a heating unit in room #133 malfunctioning on 12-15-22 and not repaired until 12-18-22. This posed a potential health and safety risk to residents in care.
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Licensee will submit a plan outlining to process of auditing heating and air units, as well as other key facility components to ensure their functionality. Plan to be submitted to LPA by POC due date.
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: 01/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
12/19/2022 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20221219095046

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: 88DATE:
01/26/2023
UNANNOUNCEDTIME BEGAN:
02:14 PM
MET WITH:Sara MackedsyTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Facility staff are not dispensing medication to resident as prescribed by a physician.
INVESTIGATION FINDINGS:
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On 1-26-23 at 2:14pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver complaint findings for the allegation listed above. LPA met with Administrator Sara Mackedsy and explained the purpose of the visit. During this investigation LPA conducted interviews with Administrator and Staff3 (S3). Additionally, LPA reviewed medication training records, medication log sheets for resident1 (R1), physician’s orders for R1, and additional email communication submitted by facility.
Based on interviews and record reviews it was determined that resident1 (R1) had multiple Physician orders for blood pressure medications Amlodipine and Enalapril to be dispensed to R1 up until 11-8-22. A physician’s order to stop the above medications was written on 11-9-22. Based on review of medication log sheets, it was revealed R1 had not received medication as of 11-9-22 per physician’s order. An additional order for medication Zoloft was written on 7-21-22 with instructions to give for “30 days.” Per physician orders, facility staff did not dispense medication after 30 days past the start date of 7-21-22.
{Cont. on 9099C}
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
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 5
Control Number 27-AS-20221219095046
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: 01/26/2023
NARRATIVE
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All additional medications for R1 were reviewed on medication log sheets and it was revealed based on documentation contained that R1 was receiving medications as ordered. As a result, there is a not a preponderance of evidence to conclude facility staff did not dispense medication as prescribed by a physician, therefore, this allegation is UNSUBSTANTIATED.

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: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5