392701014-12-14-2023-27-AS-LRIS-CYHPNM-20231214102809

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392701014
Report Date: 11/22/2023
Date Signed: 12/14/2023 09:27:09 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/23/2023 and conducted by Evaluator Renee Campbell

COMPLAINT CONTROL NUMBER: 27-AS-20230623092425

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:	0	CENSUS: 86	DATE:	11/22/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Andrea Armstrong, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff do not meet residents' dietary needs
Staff do not report incidents to appropriate parties

INVESTIGATION FINDINGS:

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On 11/22/2023, Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to the facility to complete an investigation and present the findings. LPA Campbell met with Administrator Andrea Armstrong and stated the purpose of the visit.
Regarding the allegation that staff did not meet residents’ dietary needs, LPA Campbell reviewed R1’s physician’s report and observed that his dietary needs were listed as mechanical soft. When interviewed, S2 verified that staff told the kitchen about residents with special dietary needs daily. When interviewed, S3 and S4 stated that they had observed that R1's food was chopped or pureed.
Regarding the allegation that staff do not report incidents to appropriate parties, specifically, that the family was not notified of R1's falls, LPA Campbell observed 16 charting notes and 20 internal incident reports. All but three reported incidents involved notification of R1's POA. However, per the admission agreement, it is not required that the POA or emergency contact be notified of every fall that occurs.
Therefore, the following allegation was found to be UNSUBSTANTIATED 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: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Renee Campbell	TELEPHONE: (916) 206-6380
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2023

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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