486803614-2-26-2021-21-AS-BMOS-BYRS9U-20210303124118

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803614
Report Date: 02/26/2021
Date Signed: 02/26/2021 06:25:43 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/06/2020 and conducted by Evaluator Araceli Canela

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20200506141739

FACILITY NAME:	OAKWOOD MEMORY & SENIOR CARE		FACILITY NUMBER:	486803614
ADMINISTRATOR:	ESTHER ZELEDON		FACILITY TYPE:	740
ADDRESS:	1025 OAKWOOD AVENUE		TELEPHONE:	(707) 643-0473
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94591
CAPACITY:	30	CENSUS: 10	DATE:	02/26/2021
		UNANNOUNCED	TIME BEGAN:	06:00 PM
MET WITH:	Theresa Ilagan		TIME COMPLETED:	06:15 PM

ALLEGATION(S):

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Staff denies resident food.
Staff not allowing resident to consume food of their choice.
Staff yelled at resident.
Staff made an inappropriate comment towards resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) A. Canela contacted Teresa iLagan "TJ", care staff/manager at Oakwood Memory & Senior Care Facility by telephone on 2/26/2021 for the purpose of delivering findings on a complaint investigation 21-AS-20200506141739. Due to COVID – 19 precautions a facility visit is not able to be conducted at this time.

LPA received statements and gathered records. It was alleged staff denied resident food and were not allowing resident to consume food of their choice. It was reported resident R1 disclosed that staff, S1
denied R1 particular food as a means of punishment, and made R1 eat food items that R1 does not want, in order to receive other foods. LPA received several statements stating residents are all offered the same food unless they have a dietary restriction from their physician, food items are provided according to their individual health needs. Staff disclosed, most of the residents like the food but will try to accommodate them as much as possible. Staff S1 denies the allegation and stated residents are able to eat what is provided and are not stopped from eating food they purchase on their own. LPA did not receive other statements to corroborate the allegation. Continue report see LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Araceli Canela	TELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2021

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 21-AS-20200506141739

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: OAKWOOD MEMORY & SENIOR CARE	FACILITY NUMBER: 486803614
	VISIT DATE: 02/26/2021

NARRATIVE

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It was also alleged staff yelled at resident and staff made an inappropriate comment towards resident. Resident R1 reported, while sleeping, R1 had an accident (urination) and staff S1, yelled at R1 and told R1 they were too lazy to get up and go to the bathroom at night. R1 also reported a remark was made to R1 about eating too much and is getting fat like her roommate. LPA took statements, staff S1, denied yelling at R1 or any other residents. Several staff expressed, if a resident has an accident at night, they are assisted and not yelled at. It was also disclosed R1 and R1's roommate were both in normal weight. LPA did not receive any additional statements or information to verify the allegation. The Department has investigated the above allegations and determined, although the 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 above allegations are Unsubstantiated.

No citations issued. This report was emailed to facility to obtain signature.

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Araceli Canela	TELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2021

LIC9099 (FAS) - (06/04)

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