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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415601114
Report Date: 10/22/2025
Date Signed: 10/22/2025 01:39:13 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
10/09/2025 and conducted by Evaluator Komal Curley
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20251009094007
FACILITY NAME:OAKMONT OF REDWOOD CITYFACILITY NUMBER:
415601114
ADMINISTRATOR:KATHLEEN OLSONFACILITY TYPE:
740
ADDRESS:1 EAST SELBY LANETELEPHONE:
(650) 885-7992
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94063
CAPACITY:127CENSUS: 79DATE:
10/22/2025
UNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Regional Operations Specialist, Tammie SampedroTIME COMPLETED:
01:50 PM
ALLEGATION(S):
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Staff did not ensure reporting requirements were followed
INVESTIGATION FINDINGS:
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On October 22, 2025, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced complaint visit to deliver the findings for the above allegation. LPA met with Regional Operations Specialist, Tammie Sampedro and explained the purpose of the visit.

Regarding the allegation, staff did not ensure reporting requirements were following, according to the reporting party, after the alleged abuse incident that occurred on 10/3/25, the facility did not submit an incident report (LIC624) to CCLD and did not submit an APS report.

Based on records reviewed and staff interviewed, there were no incident reports submitted to CCLD regarding the alleged abuse incident that occurred on 10/3/25. The facility was unable to provide any documentation to show that an incident report or an SOC341 was submitted to CCLD.

Based on the investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC9099-D. Failure to correct the deficiencies may result in civil penalties. Report is reviewed with Regional Operations Specialist, Tammie Sampedro and a copy is provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Curley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025
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 3
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
10/09/2025 and conducted by Evaluator Komal Curley
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20251009094007

FACILITY NAME:OAKMONT OF REDWOOD CITYFACILITY NUMBER:
415601114
ADMINISTRATOR:KATHLEEN OLSONFACILITY TYPE:
740
ADDRESS:1 EAST SELBY LANETELEPHONE:
(650) 885-7992
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94063
CAPACITY:127CENSUS: DATE:
10/22/2025
UNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Regional Operations Specialist, Tammie SampedroTIME COMPLETED:
01:50 PM
ALLEGATION(S):
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2
3
4
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9
Staff hit resident in care
INVESTIGATION FINDINGS:
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On October 22, 2025, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced complaint visit to deliver the findings for the above allegation. LPA met with Regional Operations Specialist, Tammie Sampedro and explained the purpose of the visit.

Regarding the allegation, staff hit resident in care, according to the reporting party, on 10/3/25, Staff 1 (S1) allegedly hit Resident 1 (R1).

During the investigation, LPA reviewed records, interviewed S1, R1, and R1's private caregiver. According to S1, he/she denied this allegation and stated that he/she would never hit or abuse any resident in care. S1 indicated that this situation is retaliation because S1 did not gossip with R1 regarding the PM shift. According to R1, S1 hit him/her on the thighs and it was pinkish/red, however S1 indicated there were no witnesses and no photos. Furthermore, according to R1's private caregiver, he/she did not witness the incident. Based on records reviewed, the former administrator did not endorse the incident to the current staff nor was there documentation regarding this incident.

Based on interviews conducted and documents reviewed, the department has determined that although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. Report is reviewed with LPA met with Regional Operations Specialist, Tammie Sampedro and a copy is provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Curley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 14-AS-20251009094007
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: 10/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/23/2025
Section Cited
CCR
87211(a)(1)
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87211 Reporting Requirements:
(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below...
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Licensee to submit an in-service training regarding reporting requirements with staff who document LIC624s to submit to CCLD.
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This regulation is not met as evidenced by: Based on records reviewed and staff interviewed, there were no incident reports submitted to CCLD regarding the alleged abuse incident that occurred on 10/3/25. The facility was unable to provide any documentation to show that an incident report or an SOC341 was submitted to CCLD which poses an immediate health and safety risk to residents in care.
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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.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Curley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3