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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701272
Report Date: 12/12/2024
Date Signed: 12/13/2024 08:36:26 AM

Unsubstantiated


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
09/25/2024 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240925092906
FACILITY NAME:OAKMONT OF LODIFACILITY NUMBER:
392701272
ADMINISTRATOR:ARMSTRONG, ANDREAFACILITY TYPE:
740
ADDRESS:2905 REYNOLDS RANCH PARKWAYTELEPHONE:
(209) 310-1512
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:136CENSUS: 93DATE:
12/12/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Andrea ArmstrongTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Licensee does not ensure that staff are adequately trained.
Staff do not ensure that resident is administered medication(s) according to physician's instructions.
Staff do not ensure that residents' medications are ordered on a timely basis.
Staff retaliated against resident in care.
INVESTIGATION FINDINGS:
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Unannounced complaint visit made out to this facility on 12/12/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Andrea Armstrong.
A brief interview was conducted with the facility designated Administrator at this time.
Current census was 93 residents.
The purpose of this complaint visit was to complete this investigation and present the findings to this facility, and its representative, at this time.
Based on a review of the forms and documents submitted into CCL, it was learned that facility staff were originally on boarded for a duration of 4 weeks after their date of hire. The total number of hours for the first 4 weeks of training amounted to a total of 41 hours. It was learned that 2 hours out of the overall 41 hours were dedicated to Personal Protective Equipment (PPE) and Infection Control and Prevention training.
Based on a review of the facility medication room located on the first floor, It was learned that resident medications were centrally stored in mobile carts that were observed to be locked and made inaccessible to the residents at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
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 5
Control Number 27-AS-20240925092906
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 LODI
FACILITY NUMBER: 392701272
VISIT DATE: 12/12/2024
NARRATIVE
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Based on a review of the facility policies and procedures for medication management, facility staff classified as medication technicians were tasked with handling, dispensing, and documentation of the resident medications.
It was learned that this facility employed an electronic medication administration record (E-MAR) system which required medication technicians to log in, verify that the medications corresponded to the correct resident, and initialed into this system after dispensing the medications to the residents in care. A review of this E-MAR system was conducted at this time.
It was learned that there were facility residents who were prescribed narcotics by their attending licensed medical professional as well. Based on a review of the policies and procedures for handling, dispensing, and documentation of the resident narcotics, it was learned that the incoming shift would always conduct a count with the outgoing shift to make sure that the dispensed dates were correct, narcotics count numbers were aligned, and any changes or re-orders were addressed at that time.
A review of the narcotics medication administration record was conducted at this time.
It was learned that there were a total of 29 facility residents who did not require their medications to be centrally stored by this facility and it's staff. It was learned that these residents were deemed capable by their licensed medical professionals to be able to store and self care with their medications at this time.
Based on interviews conducted during the course of this investigation, it was learned that there weren't any issues in regards to staff retaliating against facility residents at any time. It was learned that there have not been any incidents reported to this facility at this time.

As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegations finding of Unsubstantiated meant that although the allegations may have happened or were valid, there was not a preponderance of the evidence to prove that the alleged violations occurred.

There were no deficiencies observed or cited at this time.

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

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
09/25/2024 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240925092906

FACILITY NAME:OAKMONT OF LODIFACILITY NUMBER:
392701272
ADMINISTRATOR:ARMSTRONG, ANDREAFACILITY TYPE:
740
ADDRESS:2905 REYNOLDS RANCH PARKWAYTELEPHONE:
(209) 310-1512
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:136CENSUS: 93DATE:
12/12/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Andrea ArmstrongTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Licensee does not ensure that there are enough staff to provide care and supervision to residents in care.
INVESTIGATION FINDINGS:
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Unannounced complaint visit made out to this facility on 12/12/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Andrea Armstrong.
A brief interview was conducted with the facility designated Administrator at this time.
Current census was 93 residents.
The purpose of this complaint visit was to complete this investigation and present the findings to this facility, and its representative, at this time.
Based on a review of the forms and documents conducted during the course of this investigation, it was learned that this facility employed a total of 30 personnel given the responsibilities to deliver adequate care and supervision, as well as, medication management.
Of these 30 facility personnel, 24 of them were classified as caregivers while only 6 facility personnel were classified as Medication Technicians.
It was learned that this facility maintained (3) shifts for their personnel to be scheduled. These (3) shifts covered the AM, PM, and NOC shifts.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20240925092906
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 LODI
FACILITY NUMBER: 392701272
VISIT DATE: 12/12/2024
NARRATIVE
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It was learned that for the caregivers currently employed at this facility, there were 11 put onto the AM shift (0600 to 1430 hours).
It was learned that there were 10 put onto the PM shift (1400 to 2230 hours) and 4 scheduled for the NOC shift (2200 to 0630 hours).
It was learned that of the 11 facility caregivers scheduled for the AM shift, only 9 of them were considered to be full time who were scheduled to work 4-5 days a week. It was learned that 1 caregiver split their days with the PM shift and another caregiver only worked the weekends (Saturday and Sunday) only.
It was learned that there were 4 Medication Technicians scheduled for the AM shift (0630 to 1430 hours). There were 3 Medication Technicians who were scheduled for the PM shift (2230 to 0630 hours) but these individuals split their days and were also scheduled with the AM shift. It was learned that these Medication Technicians would work 2 days on the AM shift and then work 3 days for the PM shift.
It was learned that there was currently only one Medication Technician scheduled for the NOC shift (2200 to 0630 hours) at this time. This medication technician for the NOC shift was only on schedule 4 days a week at this time. It was observed that there wasn't another medication technician scheduled at this time to cover the other 3 days for the NOC shift.

As a result of this investigation, this LPA found the allegation to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met.

The following deficiencies were observed and cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes.

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

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

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20240925092906
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 LODI
FACILITY NUMBER: 392701272
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/13/2024
Section Cited
CCR
87411(a)
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Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section
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The facility designated Administrator stated that a plan will be developed to address the need for staffing for all shifts at all times. A statement of correction, along with the details of the staff hiring plan, will be completed and submitted into CCL by the due date.
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87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services.
This facility was found to be deficient as evidenced by a review of the facility personnel report which did not contain adequate staffing for all shifts at all times posing an immediate threat to the Health, Safety, and Personal Rights of residents in care.
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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: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5