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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701272
Report Date: 09/25/2025
Date Signed: 10/13/2025 10:25:56 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
08/28/2025 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250828084237
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: 84DATE:
09/25/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Andrea ArmstrongTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff do not ensure PRN medication is used as prescribed for resident in care

Licensee does not ensure staff is capable of performing job duties
INVESTIGATION FINDINGS:
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Unannounced complaint visit made out to this facility on 09/25/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Andrea Armstrong, who was briefly interviewed at this time.
Current census was 84 residents.
The purpose of this visit was to finalize this complaint and present the findings of this investigation to this facility, and it's representative, at this time.
Based on a review of the facility policies and procedures for staff handling, dispensing, and documentation of the resident PRN medications, as well as the e-Mar system used at this time, it was observed that the PRN medications were dispensed and documented as required.
It was observed that all PRN medications dispensed to the residents were entered into the e-Mar system with the corresponding notes displayed at the end of this report under the section of Pass Notes. It was observed that all PRN medications dispensed were documented for the date, time, and reason for giving it unto the resident at that time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025
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
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
08/28/2025 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250828084237

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: 84DATE:
09/25/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Andrea ArmstrongTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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9
Staff does not ensure residents medications are properly managed
INVESTIGATION FINDINGS:
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Unannounced complaint visit made out to this facility on 09/25/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Andrea Armstrong, who was briefly interviewed at this time.
Current census was 84 residents.
The purpose of this visit was to finalize this complaint and present the findings of this investigation to this facility, and it's representative, at this time.
A sample record review for facility resident medication administration records was conducted for prescribed and PRN medications, which was conducted for the months of June 2025, July 2025, August 2025, and the first week in September 2025 for a total of 10 residents.
It was observed that there were a total of (23) medications that were prescribed for the facility residents which were not properly dispensed as ordered by the licensed medical professional. It was observed that on the dates of 06/02/2025 and 08/02/2025, during the evening shift, the medications that were prescribed to be dispensed at that time unto the residents were not given. It was observed that the initials, and notes, for the
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20250828084237
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: 09/25/2025
NARRATIVE
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dates of 06/02/2025 and 08/02/2025 were missing without explanation or reasons at that time.
Based on a review of the eMAR system utilized by this facility at this time, the section where notes and information would be entered if the medications were missed, refused, or not given did not have any information entered at this time.
Based on interviews conducted during the course of this investigation, it was learned that if a date where the required initial and notes were not present in the eMar system then it would be considered that the medication was not properly dispensed to the resident at that time and missed for that time frame.

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: 09/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20250828084237
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: 09/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
09/26/2025
Section Cited
CCR
87465(a)(4)
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Incidental Medical and Dental Care
A plan for incidental medical and dental care shall be developed by each facility. The licensee shall assist residents with self administered medications as needed. This requirement was not met as evidenced by:
Based on a review of the facility
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The facility designated Administrator stated that an audit of the facility medication administration records will be conducted for both the Assisted Living and Memory Care (Traditions) components. Training, for no less than (1) hour in duration, will be conducted on the topic of proper handling,
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medication administration record (MAR) and Controlled Medication Administration Record, it was observed that required initials/notes for prescribed medications were missing indicating that they were not properly dispensed which poses/posed an immediate risk to the health, safety, and personal rights of the residents in care.
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dispensing, and documentation of all facility resident medications. A statement of correction, along with proof of updated medication training, will be completed and submitted into CCL by the due date. Proof of training will include name of trainer, training topic(s), and list of 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: 09/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20250828084237
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: 09/25/2025
NARRATIVE
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Based on a review of the facility policies and procedures for facility personnel for all ranges of assigned tasks. duties, and classifications, it was observed that each classification came with it's own unique set of skills and requirements.
It was observed that these classifications ranged from the following:

Wait Staff
Care Staff
Medication Technicians
Housekeepers
Kitchen staff
Activities staff

It was observed that all of these classifications had their own training requirements in order for these assigned staff to be able to perform and conduct their assigned tasks and duties.
A review of the facility personnel records revealed that annual training was completed for all staff providing care and supervision to the residents in care. In addition, additional training sessions were conducted for medication management, personal rights, and reporting requirements.

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: 09/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5