392701014-1-26-2023-27-AS-LKIG-CNTQ5V-20230207105235

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392701014
Report Date: 01/26/2023
Date Signed: 01/26/2023 05:16:55 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
12/14/2022 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20221214161318

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: 88	DATE:	01/26/2023
		UNANNOUNCED	TIME BEGAN:	03:45 PM
MET WITH:	Sara Mackedsy		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Lack of incontinence care

INVESTIGATION FINDINGS:

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On 1-26-23 at 3:45pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for 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 staff1 (S1). LPA also conducted a facility observation on 12-15-22. Additionally, LPA reviewed facility file documentation including service plan, physician’s report, shift report logs, staff charting notes, and email communication submitted by facility all pertaining to resident (R1). Additionally, LPA reviewed submitted photographs and facility staff assignments.
Based on interviews and record reviews, it was revealed that R1 required incontinence care during residency, and engaged in behavioral episodes including refusal to accept assistance. Records reviewed, revealed staff attempted to provide service and adhered to R1’s rights of refusal. Upon further review of facility file documentation, it was determined that facility acknowledged the need for R1’s incontinence care as demonstrated through meetings with responsible person and documented service plan for R1, but unable to meet R1’s needs. {Cont. on LIC 9099C}

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: 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 3

Control Number 27-AS-20221214161318

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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Additionally, it was determined that facility did not document and produce an appropriate formal process for managing R1’s incontinence needs per regulatory requirements for purposes of attempting to meet R1’s needs.

Based on interviews and record reviews, there is a preponderance of evidence to conclude facility did not provide appropriate levels of incontinence care due to a lack of a formal documented managed care incontinence plan. Therefore, this allegation is SUBSTANTIATED.

Citation is issued under Title 22, Division 6 and noted on LIC 9099D. 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 King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: 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 3

Control Number 27-AS-20221214161318

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 87625(a)(1)(A-D)	1 2 3 4 5 6 7	87625 (a)(1)(A)(B)(C)(D). Managed Incontinence. (a) The licensee shall be permitted to accept or retain a resident who has a manageable bowel and/or bladder incontinence condition under the following circumstances: (1)The condition can be managed with any of the following: (A) Self care by the resident. (B) A structured bowel and/or bladder retraining program to assist the resident in restoring a normal pattern of continence. (C) A program of scheduled toileting at regular intervals. (D) The use of incontinent care products. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee will read regulation 87625 and submit a signed declaration of understanding to LPA by POC due date.
	8 9 10 11 12 13 14	Based on interviews and record reviews, licensee did not ensure appropriate incontinence care for R1 as demonstrated by an absence of a documented regulatory required managed incontinence procedure. This posed a potential health and safety risk to resident in care.	8 9 10 11 12 13 14	Licensee will evaluate residents' requiring incontinence needs and develop a formal managed incontinence care plan which shall include the necessary components listed in regulation 87625. Plan to be submitted to LPA by POC due date.
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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: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: 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)

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