392701057-5-3-2022-27-AS-SDOB-CE5VHQ-20220505162732

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392701057
Report Date: 04/29/2022
Date Signed: 05/03/2022 10:13:12 AM

Substantiated

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
02/15/2022 and conducted by Evaluator Albert Johnson

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20220215083850

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: 65	DATE:	04/29/2022
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Nayda Rosales		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility has a scabies outbreak
Facility did not notify responsible party of scabies outbreak at facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Albert Johnson made an unannounced complaint investigation on this date.

Allegation: Facility has a scabies outbreak.

Based on records reviewed LPA was able to determine that R1 was being treated for scabies as indentified on the Physician's report dated 2/28/2022. R1 was treated with Elimite effectively for Scabies. This event was supported by discharge papers dated 8/26/2021 from Sutter Health for R2 who was treated with Hydroxyzine HCI and Permethrin for Scabies and R3 that was treated on 8/24/2021 with Cephalexin and Permethrin.

Continued

Substantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert Johnson	TELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022

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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Control Number 27-AS-20220215083850

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: OAKMONT OF BROOKSIDE	FACILITY NUMBER: 392701057
	VISIT DATE: 04/29/2022

NARRATIVE

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Allegation: Facility did not notify responsible party of scabies outbreak at facility.

Based on records reviewed and interviews conducted the facility did not notify the responsible parties (RP) of the events from 8/18/2021 through 2/18/2022 that were happening for treatment of Scabies at the facility. RP were told that the facility did not have a doctor that would come to the facility to do a skin scrape to confirm Scabies as the primary causes of the rashes on multiple residents. The facility was aware of the outbreak from discharge papers dated 8/26/2021 that identified Scabies as the issue addressed for R2.

The department has concluded the investigation, the preponderance of evidence standard has been 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,

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert Johnson	TELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20220215083850

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: OAKMONT OF BROOKSIDE	FACILITY NUMBER: 392701057
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/29/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/30/2022 Section Cited CCR 87470(b)1-3(c)1A-F	1 2 3 4 5 6 7	(b) In addition to subsection (a), when one or more residents in the facility are diagnosed with a communicable disease, the following shall apply: (1) In addition to the requirements of subsection (a)(2), assigned staff and volunteers, regardless of having direct contact with clients, shall be required to perform enhanced environmental cleaning and disinfection to maintain a safe and sanitary environment and to prevent, contain, and mitigate the transmission of the communicable disease. Enhanced environmental cleaning and disinfection shall be of: (A) all frequently touched surfaces such as doorknobs, handles, and shared items, as well as, (B) when one or more client(s) has a communicable disease, in any impacted areas, and immediately after contact with a client who has a communicable disease. (2) All staff and volunteers providing direct care to a resident who has a communicable disease shall wear appropriate Personal Protective Equipment (PPE) to prevent exposure to infectious agents or chemicals through the respiratory system, skin, or mucous membranes of the eyes, nose, or mouth. PPE may include gloves, gowns, masks, respirators, shoe coverings and eye protection. ....	1 2 3 4 5 6 7	The licensee will develop a plan for notifiying and addressing outbreaks at the facility. The plan will be submitted to the department by POC date.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by records reviewed and interviews conducted. The facility failed to address the infection response protocols. This is an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert Johnson	TELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022

LIC9099 (FAS) - (06/04)

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