392701272-1-17-2024-27-AS-KHOS-CZRR5Y-20240123114354

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392701272
Report Date: 01/17/2024
Date Signed: 01/17/2024 01:50:16 PM

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
11/14/2023 and conducted by Evaluator Avelina Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20231114094113

FACILITY NAME:	OAKMONT OF LODI		FACILITY NUMBER:	392701272
ADMINISTRATOR:	SMITH, EUGENIA		FACILITY TYPE:	740
ADDRESS:	2905 REYNOLDS RANCH PARKWAY		TELEPHONE:	(209) 310-1512
CITY:	LODI	STATE: CA	ZIP CODE:	95240
CAPACITY:	136	CENSUS: 85	DATE:	01/17/2024
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Andrea Armstrong		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff is stealing resident's medication.
Facility not following admission agreement by charging visitors for liquor.

INVESTIGATION FINDINGS:

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On 01/17/2024 at 9:15 AM, Licensing Program Analyst (LPA) Avelina Martinez arrived at the facility unannounced to deliver complaint findings. LPA Martinez met with Andrea Armstrong during today’s visit and explained the purpose of the visit.

Throughout the course of this investigation, LPA Martinez conducted interviews, reviewed facility records, and conducted tours of the facility. LPA Martinez conducted a controlled drug administration audit with facility staff. The audit consisted of reviewing eight resident's controlled drug administration records. Facility staff counted the controlled medication during the audit, and the medication count was correct. There were no missing controlled medication during the audit on December 14, 2023.

Continued...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Avelina Martinez	TELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

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 2

Control Number 27-AS-20231114094113

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: 01/17/2024

NARRATIVE

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A records review of resident's 1 (R1) controlled drug administration record starting on November 12, 2023 thru December 11, 2023 indicated R1's Hydrocodone 5-325 MG medication tablet count was off, and missing one medication tablet, which was unaccounted for. However, there was not enough evidence to prove facility staff were stealing medication. Please refer to January 17, 2024 case management for incidental and medical deficiencies.

Moreover, LPA Martinez reviewed resident 2's (R2) admission agreement, billing statements, and facility meal receipts. It was learned R2 was charged on $12.93 on December 04, 2022 for a meal that was not ordered by R2. Furthermore, LPA Martinez went over the incorrect charges with kitchen staff and the Administrator on December 14, 2023. At this time, it was confirmed R2 was charged incorrectly. The facility at this time is reviewing the charge, and will reimburse if needed.

LPA Martinez reviewed R2's 2022 and 2023 Meal billing records and meal receipts. The meal receipts did not indicate R2 was being charged for alcoholic beverages. Therefore, there is not enough evidence to prove that R2 was being charged for alcoholic beverages. Furthermore, R2's admission agreement on page 21 states, " Alcohol is available for purchase in the bar and lounge and in the restaurant at dinner. See current pricing on the menus. Pricing may change or vary as menus change." According to R2's admission agreement R2 agreed to the alcohol services.

Due to the above noted information, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, and therefore the allegation are unsubstantiated

SUPERVISOR'S NAME: Liza King	TELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Avelina Martinez	TELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

LIC9099 (FAS) - (06/04)

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