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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701057
Report Date: 03/30/2026
Date Signed: 04/03/2026 12:55:28 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, 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
12/05/2025 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251205104108
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: 78DATE:
03/30/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Tracy BurkeTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Staff opened a resident's personal delivery
INVESTIGATION FINDINGS:
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On 3/30/2026, LPA Johnson arrived unannounced to deliver finding for the above allegation. LPA met with Tracy Burke.


Allegation: Staff opened a resident's personal delivery

Based on interviews and information reported R1 stated that his Amazon Pharmacy medication delivery was sent to the facility’s med-tech room. R1 reported that staff opened the package without his knowledge or consent.

Continued
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2026
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 4
Control Number 27-AS-20251205104108
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: 03/30/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/10/2026
Section Cited
CCR
87468.1(a)(1)
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(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons.
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The facility shall submit a plan on how this will not occur in the future along with a current in- service training on 87468.1 personal rights by POC due date.
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This requirement is not met as evidenced by R1 not granted permission for staff to open pharmacy deliveries on his behalf. This is a personal right violation.
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Please provided documentation to CCL by POC
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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: 03/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
12/05/2025 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251205104108

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: DATE:
03/30/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Tracy BurkeTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Staff verbally abused a resident
INVESTIGATION FINDINGS:
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During the investigation, interviews and available information did not produce sufficient evidence to support that verbal harassment or retaliation occurred. No witnesses corroborated that the Executive Director engaged in verbal harassment, intimidation, or retaliatory behavior toward R1. Documentation reviewed did not show any actions taken by the Executive Director that restricted R1’s rights, limited his participation in the Resident Council, or resulted in punitive measures. While R1 may have felt uncomfortable or disagreed with the Executive Director’s feedback, the evidence does not demonstrate that the conduct rose to the level of harassment or retaliation as defined by regulation.

Although the concern may have occurred or may be valid to some degree, there is not a preponderance of evidence to prove that the Executive Director verbally harassed or retaliated against R1. Therefore, the allegation is UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 27-AS-20251205104108
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: 03/30/2026
NARRATIVE
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R1 stated staff told him they “shook the package and it sounded like pills,” which led them to take possession of it. R1 reported that he did not authorize staff to open his personal packages.

During the investigation, the facility did not provide documentation showing that R1 had delegated medication management team to open or granted permission for staff to open pharmacy deliveries on his behalf. Without such authorization, staff opening a resident’s personal package constitutes interference with the resident’s personal rights. Substantiated.

Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies were observed and cited during this visit.

Exit interview held.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4