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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415601114
Report Date: 12/14/2023
Date Signed: 12/14/2023 03:14:11 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/25/2023 and conducted by Evaluator Jaime Vado
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20230725115745
FACILITY NAME:OAKMONT OF REDWOOD CITYFACILITY NUMBER:
415601114
ADMINISTRATOR:LAYANA SANTOSFACILITY TYPE:
740
ADDRESS:1 EAST SELBY LANETELEPHONE:
(650) 885-7992
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94063
CAPACITY:127CENSUS: 43DATE:
12/14/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Business Office Director Ana GobelezaTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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- Staff are not following infection control requirements.
INVESTIGATION FINDINGS:
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On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit in order to deliver findings regarding the above allegation. LPA met with Business Office Director Ana Gobeleza and explained purpose of today's visit.

During the course of the investigation LPA conducted multiple interviews and reviewed protocols with previous administrator Meghan Leone. LPA discovered that there was not enough COVID test kits on hand during an outbreak in memory care. Additionally, isolation procedures, social distancing, appropriate signs, hand sanitizer, gowns, and masking requirements were not being fully adhered to during the outbreak. Residents were congregating despite of COVID status and there was a lack of PPE being utilized to help mitigate the spread of COVID. This allegation is substantiated.

Based on LPA interviews and items letters received, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, are being cited on the attached LIC9099D.

Report is reviewed with Ana Gobeleza. Appeal rights are provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023
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 14-AS-20230725115745
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: OAKMONT OF REDWOOD CITY
FACILITY NUMBER: 415601114
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/15/2023
Section Cited
CCR
87468.1(a)(2)
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87468.1 Personal Rights of Residents in All Facilities - (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.

This regulations has not been met as evidenced by:
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The licensee shall comply with the regualtion stated herewithin. The licensee/facility shall revisit infection control protocols and resubmit to licensing. A written statement of correnction and invection control plan of such shall be recieved by the POC date.
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Per interviews conducted the facility did not have enough COVID test kits to test residents with symptoms of COVID in memory care. isolation procedures, social distancing, appropriate signs, hand sanitizer, gowns, and masking requirements were not being fully adhered to during the outbreak. The facility did not provide a safe and healthful accomodation for residents.
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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.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2