392701014-4-14-2022-27-AS-KHOS-CDWMHC-20220428093718

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392701014
Report Date: 04/13/2022
Date Signed: 04/14/2022 07:04:31 AM

Unsubstantiated

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
03/21/2022 and conducted by Evaluator Bruce Jacobs

COMPLAINT CONTROL NUMBER: 27-AS-20220321154331

FACILITY NAME:	OAKMONT OF LODI		FACILITY NUMBER:	392701014
ADMINISTRATOR:	PRYOR, JESSICA		FACILITY TYPE:	740
ADDRESS:	2905 REYNOLDS RANCH PARKWAY		TELEPHONE:	(949) 744-5200
CITY:	LODI	STATE: CA	ZIP CODE:	95240
CAPACITY:	136	CENSUS: 89	DATE:	04/13/2022
		UNANNOUNCED	TIME BEGAN:	12:10 PM
MET WITH:	Jessica Pryor, Executive Director		TIME COMPLETED:	03:25 PM

ALLEGATION(S):

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Facility did not ensure sufficient staffing to meet resident(s) needs

Staff left residents in care unsupervised resulting in resident altercations

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bruce Jacobs arrived at the facility and met with Facility Administrator Jessica Pryor to conduct additional interviews, obtain records and deliver investigation findings for the above allegations. This investigation consisted of site inspections to the facility to conduct interviews with the facility administrator, staff and other witnesses. LPA reviewed and obtained copies of pertinent documents in the resident's (R-1) file.

This investigation concluded after several LPA inspections, interviews and record reviews that there was not sufficient information to prove that staff left residents unsupervised resulting in resident altercations..There was no documentation of specific altercation alleged in the complaint report and staff could recall no incidents of that type during interviews. There was not sufficient information to prove with a preponderance of evidence that the facility is not providing a sufficient level of staffing in both Memory Care and Assisted Living. Interviews and a review of the staffing schedule did not provide sufficient and consistent information to prove the allegation to be true.

Based on LPA’s observations and interviews conducted, the preponderance of evidence standard has not been met, therefore the above allegations are determined to be UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Bruce Jacobs	TELEPHONE: (916) 956-5861
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022

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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