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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701057
Report Date: 04/18/2025
Date Signed: 04/18/2025 11:47:59 AM

Substantiated


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
01/28/2025 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250128134248
FACILITY NAME:OAKMONT OF BROOKSIDEFACILITY NUMBER:
392701057
ADMINISTRATOR:TRACY BURKEFACILITY TYPE:
740
ADDRESS:3318 BROOKSIDE ROADTELEPHONE:
(209) 473-1300
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY:81CENSUS: 80DATE:
04/18/2025
UNANNOUNCEDTIME BEGAN:
09:24 AM
MET WITH:Tracy BurkeTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Facility is in disrepair.
Licensee does not ensure that residents are provided a comfortable environment while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to deliver findings for complaint investigation for the allegations noted above. LPA met with Administrator and explained the purpose of the visit.

Allegation: Facility is in disrepair. Based on records reviewed and interviews with the Administrator and staff. The facility had a broken alarm system (wander management system) This was reported to the facility Administrator on 9/24/2024. The alarm system was triggering more frequently than usual from 9/24/2024 through 10/23/2024. The facility did not have a Maintenance Director at the time of the incidents and the staff or Administrator would have to call Phillips lifeline systems to have the system reset.
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2025
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-20250128134248
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: OAKMONT OF BROOKSIDE
FACILITY NUMBER: 392701057
VISIT DATE: 04/18/2025
NARRATIVE
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The facility does not have records of correspondence with Phillips regarding the frequency of the incidents are the calls to them to reset the system. However, the facility has requested time to get this information by next week 4/25/2025.

The facility continued to have issues with the system triggering each time the alarm was triggered the staff would have to put a code in to stop the system. This continued until 10/23/2024 when the system was repaired. Although the facility is not in disrepair the facility did have a broken system that when triggered provide resident in care with and without hearing impairments a very uncomfortable environment.

Allegation: Licensee does not ensure that residents are provided a comfortable environment while in care. Based on the review of records the facility provides care to residents with cognitive impairment as well as hearing impairment. The use of auditory alarms that alert staff to residents attempting to leave is what the facility chooses to use, however, based on the repair and auditory frequency of the alarm going off the residents in care with or without hearing impairments were subjected to the noise and as a result were exposed to a uncomfortable environment.

The department concluded the initial investigation and the preponderance of evidence standard was met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8) are being cited on the attached LIC-9099D. Failure to correct the deficiency may result in civil penalties. Appeal rights were provided.  An exit interview was conducted.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Citations on this Visit Report are Under Appeal!

Control Number 27-AS-20250128134248
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: OAKMONT OF BROOKSIDE
FACILITY NUMBER: 392701057
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
04/25/2025
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement was not met as evidenced by records reviewed
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The facility repaired the system of 10/23/2024. The facility provided an invoice #1307 dated 1/30/2025 and currently uses a remote to stop the alarm when triggered.
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The alarm system was triggering more frequently than usual from 9/24/2024 through 10/232024. The facility did not have a Maintenance Director at the time of the incidents and the staff or Administrator would have to call Phillips lifeline systems to have the system reset after putting a code in to stop the alarm.
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The facility submitted a letter to the Division of Occupational
Safety and Health dated 3/26/2025 regarding complaint # 2274922 with inaccurate information about the Department's findings and will need to report the current findings to Mr. Valadez of the Dept. of Industrial Relations(DIR)/ Division of Occupational Safety and Health by 4/21/2025. The Department will also cross report the current and accurate findings to DIR.
Under Appeal
Type B
04/25/2025
Section Cited
CCR
87468.1(a)(2)
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87468.1 Personal Rights of Residents in All Facilities

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
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The facility repaired the system of 10/23/2024. The facility provided an invoice #1307 dated 1/30/2025 and currently uses a remote to stop the alarm when triggered.
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This requirement was not met as evidenced by based on the repair and auditory frequency of the alarm going off the residents in care with or without hearing impairments were subjected to the loud noise and as a result were exposed to a uncomfortable environment.
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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.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3