392701272-4-27-2026-27-AS-LKIG-DU2QLZ-20260513121645

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392701272
Report Date: 04/27/2026
Date Signed: 04/27/2026 03:54:49 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
11/21/2025 and conducted by Evaluator Arielle Pascua

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20251121113746

FACILITY NAME:	OAKMONT OF LODI		FACILITY NUMBER:	392701272
ADMINISTRATOR:	ARMSTRONG, ANDREA		FACILITY TYPE:	740
ADDRESS:	2905 REYNOLDS RANCH PARKWAY		TELEPHONE:	(209) 310-1512
CITY:	LODI	STATE: CA	ZIP CODE:	95240
CAPACITY:	136	CENSUS: 86	DATE:	04/27/2026
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Andrea Armstrong		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff do not ensure that resident is administered medication(s) according to physician's instructions.
Facility did not provide care and supervision to resident.

INVESTIGATION FINDINGS:

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Unannounced complaint visit made out to this facility on 04/27/2026 by Licensing Program Analyst (LPA) Areille Pascua. This LPA was met by the facility designated Administrator, Andrea Armstrong, who was briefly interviewed at this time.
Current census was 86 residents.
This visit was conducted in order to deliver the findings of this investigation to this facility, and its representative, at this time.
Based on a review of the forms and documents that were gathered during the course of this investigation, it was learned that R1 moved into this facility back in the early part of 2023. It was learned that R1 was already diagnosed as being non ambulatory but resided originally in the Assisted Living portion of this facility at that time. The resident was already diagnosed and with back pain and constipation upon admission to this facility.
It was learned that R1 eventually was diagnosed with dementia and was moved over to the memory care portion, Traditions, of this facility at a later date. This diagnosis was reflected on the LIC 602 that was completed on 02/20/2024.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20251121113746

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: 04/27/2026

NARRATIVE

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It was learned that R1 underwent back surgery on 11/05/2025 and returned to this facility on 11/07/2025. The resident, R1, was originally prescribed and taking their pain medications which were Pregablin and Tylenol at that time.

It was learned that on 11/09/2025 a family member for R1 dropped off a new PRN medication, Hydrocodone, for pain management and provided a prescription and order for that medication at that time. However, this facility did not dispense the medication to the resident since there was not a signed order from the responsible licensed medical professional. This matter was later resolved that same day when the facility nurse contacted the pharmacy and discovered that this particular pharmacy had their licensed medical professionals digitally sign all of their orders. Since this order was completed electronically by the licensed medical professional there would not have been a signed paper copy to accompany the order at that time. The medication, Hydrocodone, was then administered to the resident, R1, as needed when R1 complained of any pain or discomfort.

Based on a review of the forms and documents that were gathered during the course of this investigation, it was learned that the new pain medication, Hydrocodone, was prescribed and filled on 11/09/2025 when it was dropped off to this facility. This medication was only a PRN and was not to be dispensed on a daily basis but only when the resident, R1, expressed pain and discomfort. It was learned that from 11/09/2025 to when the resident got their staples removed from their back surgery on 11/19/2025, this medication was dispensed a total of 11 times to the resident. Each time this medication was dispensed it was noted and entered into the facility Medication Administration Record (MAR) and charting notes as well. It was learned that the daily tasks assigned to the facility staff were completed and signed off after the completion of each shift for care and supervision to the R1.

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: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026

LIC9099 (FAS) - (06/04)

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