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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701272
Report Date: 03/25/2024
Date Signed: 03/26/2024 03:39:14 PM


Document Has Been Signed on 03/26/2024 03:39 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



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: 87DATE:
03/25/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Andrea Armstrong TIME COMPLETED:
03:17 PM
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An Informal Non-Compliance Conference (NCC) was conducted today on March 25, 2024 via Microsoft Teams with the Sacramento South Regional Office at 1:30 PM. Present at today's meeting include the following: Licensing Program Manager Stephenie Doub, Licensing Program Manager Liza King, and Licensing Program Analyst Avelina Martinez: Facility Representatives: Andrea Armstrong, Scott Carlson, Sue Mcpherson, Elaine Wong, Joel Goldman; Ombudsman Representative: Kathryn Thomas.

The Non-Compliance Conference process was explained during this meeting; also, to include the Administrative process.

In the last year, the facility has been cited a total of six times. The facility received four A citations and two: B citations. The citations consist of the following: Care and Supervision and Incidental, reporting requirements, and incidental and medical.

Issues discussed during the Non-Compliance Conference were:
  2. Complaint Number 27-AS-20231107162650- Lack of Care and Supervision
  3. Medication Errors
  4. Staffing Concerns
  5. Reporting Requirements
  6. Medication Training
  7. Facility Polices Regarding: Assessments, Monitoring of residents, Change in condition, Medication errors.


Continued...
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:
DATE: 03/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 03/25/2024
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The facility has stated they will do the following to achieve continued and substantial compliance:
  • Submit facility medication training documentation and procedures to Community Care Licensing Department (CCLD) by 03/29/2024 by 5:00 PM
  • Submit a recent hospital discharge notes, reassessment, updated medication orders, and staff training on care and service needs by 03/29/2024 5:00 PM
  • Request Technical Support Program (TSP) if needed.
  • Submit updated policy on resident checks/monitoring by 03/29/2024 5:00 PM
  • Submit assessment procedures by 03/29/2024 5:00 PM

In addition, at this meeting the Licensee and facility management were advised future non-compliance regarding the above and other regulatory components will result in additional citations, civil penalties, and further potential administrative action.

Community Care Licensing Department (CCLD) will do the following:

  • Increase monitoring to quarterly visits for 1 year.
  • Technical Support Program (TSP) referral. (A referral will be completed when Licensee advises CCLD of TSP need).
  • TSP website materials were emailed to Oakmont of Lodi staff. Technicalsupportprogram@dss.ca.gov

Completing the Non-Compliance Conference does not deprive the Department of its authority to take appropriate formal legal action under the Health and Safety Code if such action is deemed necessary by the Regional Manager.

Per California Code of Regulations (CCRs) - Title 22 no deficiencies are being cited at this visit. An exit interview was conducted with facility staff, and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024
LIC809 (FAS) - (06/04)
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