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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701272
Report Date: 04/28/2025
Date Signed: 04/29/2025 11:43:45 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
12/19/2024 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20241219144803
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: DATE:
04/28/2025
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Andrea ArmstrongTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not provide activities to residents in care
INVESTIGATION FINDINGS:
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Unannounced complaint visit made out to this facility on 04/28/2025 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 visit was to deliver the findings from this investigation to this facility, and its representative, at this time.
Based on a review of the facility posted activities calendar for each month, it was observed that activities for the memory care unit, Traditions, usually started as early as 0900 in the mornings and held events after lunch and in the evening hours. It was also observed that outings were sometimes offered on Friday evenings as well.
Based on further review, it was learned that this facility also offered scenic drives for the facility residents depending on the weather and overall participation rate.
Based on a review of the forms and documents provided to this LPA by this facility, it was learned that this
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025
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-20241219144803
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: 04/28/2025
NARRATIVE
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facility maintained a sign up sheet and took attendance for all residents living in the Traditions unit who attended and took part in these activities throughout the day.
It was observed that participation was always voluntary but residents were always encouraged to engage as much as they could depending on their physical and mental limits and abilities.
It was observed that the lowest number of participants would range from 7-10 participants for any given activity and go up to as high as a 60% participation rate depending on the event and mood of the residents during that time.
It was observed that activities were being offered to the residents in the Traditions unit on a daily basis but that the residents still had the right to refuse or participate if they chose to do so.

As a result of this investigation, this Department found the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegation may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation 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: 04/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025
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
12/19/2024 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20241219144803

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: DATE:
04/28/2025
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Andrea ArmstrongTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not ensure resident in care was kept dry
INVESTIGATION FINDINGS:
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Unannounced complaint visit made out to this facility on 04/28/2025 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 visit was to deliver the findings from this investigation to this facility, and its representative, at this time.
Based on a review of the facility forms and documents provided to this LPA by this facility, it was learned that there were a total of (7) residents who were deemed to be incontinent of either bowel and/or bladder who resided in the memory care unit, Traditions, of this facility at this time.
It was learned that each resident in the Traditions unit had their own care plan which outlined the levels of care that they were supposed to receive on a daily basis. These could range from assistance with dressing, bathing, and grooming to name just a few.
Based on a review of the facility resident care plans for residents requiring assistance with toileting, it was
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025
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-20241219144803
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: 04/28/2025
NARRATIVE
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learned that each shift of caregivers, (AM, PM, and NOC), were expected to document and initial the Staff Assignments by Month by Responsible Party at the end of their scheduled shifts. It was also learned that the responsible caregivers for each shift could also initial on this document as the staff assignments were completed throughout their shifts.
Based on a review of this document conducted for the month of April 2025, all shifts, (AM-Day, PM-Evening, and NOC-Night), the focus was done just for the staff assignment for the task of Toileting.
It was observed that there were several days on the AM-Day shift, as well as, the NOC-Night where initials were missing with no explanation or notations provided at this time.
Based on interviews conducted, it was learned that the expectation was that all caregivers were supposed to initial when the staff assignments were completed. It was learned that there should not have been any missing or blank entries throughout all shifts for staff assignments and if there were to be any blank spots then there should have been a circle with an explanation attached. It was observed that these blank spots where staff initials should have been did not have any corresponding documents or information explaining the reason for the blank spots.
Based on interviews conducted, it was learned that facility personnel would be considered, and deemed, to not have performed those assigned tasks if they did not properly initial into that day for that particular facility resident.

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 left with the facility designated Administrator at this time.

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

DATE: 04/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20241219144803
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: 04/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/29/2025
Section Cited
CCR
87625(b)(2)
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In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following:
Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night.
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The facility designated representative stated that all facility care staff providing care and supervision to the residents in care will undergo training, for no less than (1) hour in duration, on the topic of incontinence care including proper documentation. A statement of correction, along with proof of updated
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The facility was found to be deficient as evidenced by the presence of incomplete forms and documents for staff assignments not being properly filled out and initialed when tasks for proper care and supervision to the residents were completed which posed an immediate threat to the Health, Safety, and Personal Rights of residents in care.
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training, will be completed and submitted into CCL by the due date.
Proof of training will include the name of the trainer, topic(s) of discussion, and a list of all attendees.
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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: 04/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5