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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701057
Report Date: 11/14/2023
Date Signed: 11/22/2023 02:55:30 PM

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
09/27/2023 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230927085042
FACILITY NAME:OAKMONT OF BROOKSIDEFACILITY NUMBER:
392701057
ADMINISTRATOR:HOLGUIN, PATRICIAFACILITY TYPE:
740
ADDRESS:3318 BROOKSIDE ROADTELEPHONE:
(209) 473-1300
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY:81CENSUS: 77DATE:
11/14/2023
UNANNOUNCEDTIME BEGAN:
11:22 AM
MET WITH:P. HolguinTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not ensure resident's hygiene needs are being met
Resident was left in dirty clothing
Resident was served contaminated food
Facility staff do not provide adequate activities for residents
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Allegation: Facility staff did not ensure resident's hygiene needs are being met. Based on records reviewed and interviews with the staff the facility documents when a resident has been given hygiene care. LPA was able to confirm that the documentation the facility uses includes: changing clothing, showers, incontinent care, assistance and escorting with reminders for mealtimes. During the course of the investigation the department was unable to confirm that a particular resident's hygiene needs were not met.

Allegation: Resident was left in dirty clothing. Based on records reviewed and interviews conducted the facility documents when residents are assisted with choosing clothing , dressing and undressing with reminders to maintain privacy, safety, comfort and to report any decline in abilities to assist with this activity.

Allegation: Resident was served contaminated food. Based on records reviewed and interviews conducted the facility is in compliance with regulatory requirements for food service and preparation. The allegation mention that a fly was in the food of a resident when served. The facility had no record of the event (over the last three months) and those interviewed confirmed that this did not happen or was not reported by the resident council, staff or family members. LPA did not have evidence (photos or documentation) to support the allegation.

Allegation: Facility staff do not provide adequate activities for residents. Based on observation and records reviewed the facility has a current activities calendar, a staff assigned to carry out the activities and photos of residents engaging in activities. The resident council confirmed that there are improvements that can be made however they are satisfied with the variety of activities offered. Resident council also noted that the facility should given more notice when activities are cancelled.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2023
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
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
09/27/2023 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230927085042

FACILITY NAME:OAKMONT OF BROOKSIDEFACILITY NUMBER:
392701057
ADMINISTRATOR:HOLGUIN, PATRICIAFACILITY TYPE:
740
ADDRESS:3318 BROOKSIDE ROADTELEPHONE:
(209) 473-1300
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY:81CENSUS: 77DATE:
11/14/2023
UNANNOUNCEDTIME BEGAN:
11:22 AM
MET WITH:P. HolguinTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not notify appropriate parties of resident having scabies
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This matter was addressed and substantiated on the complaint report control number 27-AS-20230807125824 dated 2/15/2022. The facility was given a citation for not notify appropriate parties of a resident having scabies. The facility has not had a case of scabies since the last reported incident on 2/15/2022.

The department concluded the initial investigation and the preponderance of evidence standard was met, therefore the above allegation is found to be SUBSTANTIATED. A citation was given on 4/29/2022 with a plan of correction, therefore the department will not be re- issuing a citation for this finding.
Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2023
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 3