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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701272
Report Date: 07/23/2024
Date Signed: 07/23/2024 02:30:50 PM


Document Has Been Signed on 07/23/2024 02:30 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: 98DATE:
07/23/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Andrea ArmstrongTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Avelina Martinez arrived at facility unannounced to conduct a case management visit on 07/23/2024 at 10:50 AM. LPA Martinez met with Andrea Armstrong and explained the purpose of the visit.

The purpose of the visit today is to conduct a quarterly visit. LPA Martinez followed up with the following:
  1. Staffing Concerns: LPA Martinez will return to follow up on medication training.
  2. Medication Errors: LPA Martinez will return to the facility to follow up on medication error incident.
  3. Medication Audit: A medication Audit was completed on July 18, 2024
  4. Reporting Requirements: The Department received a medication error incident report on July 17, 2024.
  5. Medication Training: LPA Martinez will return to follow up on medication training.
  6. Facility Polices Regarding: Assessments, Monitoring of residents, Change in condition, Medication errors. LPA Martinez will return to follow up on medication training.

Quarterly Visit Review:

LPA Martinez reviewed seven resident files and conducted interviews in regards to medication errors. LPA Martinez will follow up on the seven files at a later time. LPA Martinez will conduct a continuation quarterly visit.

There were no deficiencies cited at this time, and exit interview was conducted. A copy of this report was provided to the facility.

SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:
DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/23/2024
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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