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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701272
Report Date: 02/06/2025
Date Signed: 02/07/2025 09:32:24 AM

Document Has Been Signed on 02/07/2025 09:32 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:OAKMONT OF LODIFACILITY NUMBER:
392701272
ADMINISTRATOR/
DIRECTOR:		ARMSTRONG, ANDREAFACILITY TYPE:
740
ADDRESS:2905 REYNOLDS RANCH PARKWAYTELEPHONE:
(209) 310-1512
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY: 136CENSUS: 89DATE:
02/06/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:30 PM
MET WITH:Andrea ArmstrongTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
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Unannounced case management visit made out to this facility on 02/06/2025 by Licensing Program Analyst (LPA) Charlie Yang to follow up on a substantiated allegation from prior complaint investigation, 27-AS-20231107162650, and was met by the facility designated Administrator, Andrea Armstrong, at this time.
This LPA met with the facility designated Administrator, Andrea Armstrong, and explained the purpose of the visit.
On January 17, 2024, the Department concluded a complaint investigation, which alleged the following: “Facility failed to provide care and supervision.”
The licensee was cited for California Health and Safety Code section 1569.312(e) Basic Services Requirements. This Licensee failed to monitor Resident (R1) to ensure their general health, safety, and well-being. R1 was found naked on the ground of their room after missing multiple meals. R1 was on the ground for an undetermined number of hours.
At the time of the complaint visit that was conducted on January 17, 2024, an immediate civil penalty of $500.00 was issued and the Licensee was informed that an additional civil penalty might be assessed based on Health and Safety Code Section 1569.49.
The Department has concluded an analysis and has determined that a civil penalty was warranted for serious bodily injury. The Welfare and Institutions Code section 15610.67 defines serious bodily injury as "an injury involving extreme physical pain, substantial risk of death, or protracted loss or impairment of a function of a bodily member, organ, or of mental faculty, or requiring medical intervention, including but not limited to, hospitalization, surgery, or physical rehabilitation.”
This was evidenced by information gathered through medical records and interviews that the Licensee did not ensure R1 was provided proper care and supervision.
As a result, R1 remained lying on the floor for an extended period of time, sustained serious bodily injury requiring R1 to be hospitalized, and had to receive additional care from a rehabilitation center.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 LODI
FACILITY NUMBER: 392701272
VISIT DATE: 02/06/2025
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Today, 02/06/2025, the Department will be issuing a civil penalty per Health and Safety Code Section 1569.49(f) for a violation that the Department constituted as a serious bodily injury in the amount of $10,000.00.
However, since an immediate civil penalty in the amount of $500.00 was previously issued on January 17, 2024, the amount of the civil penalty issued today will be for $9,500.00.

A copy of this report, along with a copy of the LIC 421D, was provided to the facility designated Administrator, Andrea Armstrong, at this time.

Appeal rights were printed and a copy was given to the facility designated Administrator, Andrea Armstrong, at this time.

Exit interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC809 (FAS) - (06/04)
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