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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701057
Report Date: 04/10/2023
Date Signed: 04/12/2023 10:03:22 AM


Document Has Been Signed on 04/12/2023 10:03 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 BROOKSIDEFACILITY NUMBER:
392701057
ADMINISTRATOR:HOLGUIN, PATRICIAFACILITY TYPE:
740
ADDRESS:3318 BROOKSIDE ROADTELEPHONE:
(209) 473-1300
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY:81CENSUS: DATE:
04/10/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:13 AM
MET WITH:P HolguinTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Albert Johnson arrived at facility to conduct a Case Management visit due to multiple incidents involving falls.

The resident involved in these incident were sent out to the ER and returned to the facility. The discharge summaries required that each individual be seen by their Primary care Physician (PCP).

R1 has had multiple falls in February 2023 and was sent out to the ER multiple times. R1 was assessed to address the high risk for these falls. R1 moved out of the community after receiving the updates to the service plan and the additional requirements to keep R1 safe.

R2 had a fall on April 4th of 2023 and was sent to the ER, R1 was released on the same day with orders to see their PCP in 1 to 3 days. The facility did not arrange for this follow-up, however the family followed -up with the PCP. The facility did an assessment on 12/29/22 which was signed via email or electronic signature.

R3 has had multiple falls from November of 2022 to recently on the 6th of March 2023, she was sent out on 3/6/2023 and returned with no new orders, however, she was sent again to the ER on 3/14/2023, due to back pain and returned with orders for antibiotics and pain medication.

No citation given for this visit today.

SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:
DATE: 04/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/10/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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