392701057-11-9-2023-27-AS-LRIS-CXTTP5-20231122135344

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392701057
Report Date: 10/30/2023
Date Signed: 11/09/2023 12:29:06 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 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
09/25/2023 and conducted by Evaluator Albert Johnson

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230925125951

FACILITY NAME:	OAKMONT OF BROOKSIDE		FACILITY NUMBER:	392701057
ADMINISTRATOR:	HOLGUIN, PATRICIA		FACILITY TYPE:	740
ADDRESS:	3318 BROOKSIDE ROAD		TELEPHONE:	(209) 473-1300
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95219
CAPACITY:	81	CENSUS: 77	DATE:	10/30/2023
		UNANNOUNCED	TIME BEGAN:	12:49 PM
MET WITH:	P. Holguin		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

1
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8
9

Facility staff mismanage medications.

INVESTIGATION FINDINGS:

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13

This matter was addressed and substantiated on the complaint report with the control number 7-AS-20230807125824 dated 8/28/2023. The facility was given a citation for mismanaging medication for R1 from 1/4/2022 thru 1/13/2022 and 2/6/22 thru 2/8/22. There were two medication not available for R1 on two different occasions. The facility's medication records confirmed that the medications were ordered but not available on-site.

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 8/28/2023 with a plan of correction, therefore the department will not be re- issuing a citation.

Substantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

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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