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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 10:26:42 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
08/25/2025 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250825094456
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:
03:00 PM
MET WITH:Andrea ArmstrongTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff do not ensure that resident's showering needs are met

Facility is malodorous

Staff do not ensure resident's toileting needs are being met

Staff do not safeguard resident's belongings

Staff do not respond to resident's calls for assistance
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 Staff Assignments by Month for Staff and assigned Resident, it was observed that the tasks for assisting with showers/baths were properly completed and initialed by the assigned staff at this time. A review of this report was conducted for the months of June, July, August, and September 2025.
Based on a review of the facility Staff Assignments by Month for Staff and assigned Resident, it was observed that the tasks for assisting with toileting needs were properly completed and initialed by the assigned staff at this time. A review of this report was conducted for the months of June, July, August, and September 2025.
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
08/25/2025 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250825094456

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:
03:00 PM
MET WITH:Andrea ArmstrongTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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9
Staff mismanage residents medications
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 record review for facility resident, R1, was conducted in regards to the medication administration record 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.
It was observed that there were a total of (3) medications that were prescribed for R1 which were not properly dispensed as ordered by the licensed medical professional. It was observed that on the date of 08/02/2025, during the evening shift, the medications that were prescribed to be dispensed at that time unto resident R1 were not given. It was observed that the initials, and notes, for the date of 08/02/2025 were missing without
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-20250825094456
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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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 timeframe.

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.

A civil penalty in the amount of $1000 was issued on the following LIC 421IM to this facility, and it's representative, at this time.

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-20250825094456
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-20250825094456
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 tour of the memory care unit, Traditions, it was observed that there were not any foul or bad odors detected at the time of this facility tour.
A sample review of the facility resident bedrooms, as well as the resident restrooms, was conducted. Based on this review, there were not any foul or bad odors detected at the time of this facility tour.
Based on a review of the facility theft and loss policies and procedures, it was observed that steps were put into place to address any incidents of loss by the residents and the facility's response in addressing these incidents.
It was observed that an inventory sheet was also completed, if accepted by the resident and their responsible party on the Admissions Agreement, to inventory all personal belongings upon admission to this facility. This document was also updated, as necessary, in order to safeguard the resident and their belongings. This document also protected the facility in the cases of false allegations of theft or loss suffered by the facility resident. This facility was observed to have completed the required inventory log sheets for the residents in care at this time.
Based on a review of the facility call log system, which was used by the facility residents to signal for help or assistance, it was learned that the response time for facility care staff to receive, respond, and reset the call for assistance was between 5-10 minutes. It was observed that there were incidents that were recorded outside of this timeframe but were reviewed on a case by case basis taking into account the time of day, staffing, and nature of the activation for service. It was observed that the response to the calls for service by the facility residents were being met for the 5-10 minute requirement 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: 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