496803601-2-24-2021-21-AS-CMAZ-BYQPP4-20210302102851

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803601
Report Date: 02/24/2021
Date Signed: 02/24/2021 01:31:41 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
01/29/2021 and conducted by Evaluator Kimberley Mota

COMPLAINT CONTROL NUMBER: 21-AS-20210129132311

FACILITY NAME:	OAKMONT GARDENS		FACILITY NUMBER:	496803601
ADMINISTRATOR:	DEL DOSSO, MELISSA		FACILITY TYPE:	740
ADDRESS:	301 WHITE OAK DR		TELEPHONE:	(707) 538-1914
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95409
CAPACITY:	79	CENSUS: 36	DATE:	02/24/2021
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Melissa Del Dosso, Executive Director		TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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Building and grounds
Facility is retaining a resident with prohibited health conditions
Personal rights

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mota met with Melissa Del Dosso, Executive Director, on this date for the purpose of delivering findings on the above complaint allegations. The visit was conducted via telephone due to the COVID-19 precautions. LPA did not physically present at the site.

The Department’s investigation included records review, including medical records; facility records; as well as interviews with Complainant, facility staff and outside entities. This investigation has resulted in the following determinations: Building and grounds: Complainant alleges that the elevator does not have an up-to-date inspection having expired 11/2020. LPA received documentation from the Division of Occupational Safety & Health Elevator Unit (DOSH) stating they are experiencing a six-month backlog and deem the elevator safe to use”. Continued on 9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Carla Martinez	TELEPHONE: (707) 588-5079
LICENSING EVALUATOR NAME: Kimberley Mota	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2021

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-20210129132311

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: OAKMONT GARDENS	FACILITY NUMBER: 496803601
	VISIT DATE: 02/24/2021

NARRATIVE

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DOSH further stated “the elevator permit expiring does not enable them from using the elevator nor does it deem the elevator unsafe to use”. These inspections are conducted by the DOSH unannounced and not scheduled by the facilities. Based on information obtained by the Division of Occupational Safety & Health, the allegation is determined to be unfounded.

Facility is retaining a resident with prohibited health conditions: Complainant alleges that resident (R1) has an undocumented wound that was not reported to R1’s physician. LPA reviewed records and conducted interviews. R1 states that the wound occurred on 1/12/2020 as a result of R1 falling asleep on a heating pad and reported it to the facility this same day. It was reported by R1 to the home health nurse on 1/14/2021. R1 is being treated for a separate wound by home health. Interviews with R1 indicate that due to other health concerns, R1 did not request any treatment. R1 is responsible for any medical decisions to be made on their behalf. A review of R1’s medical records indicate that R1 is independent and able to leave the facility unassisted and able to communicate needs. Due to conflicting statements and record review, the allegation is determined to be unfounded.

Personal rights: Claimant alleges that R1 states people are coming into R1’s apartment without wearing proper identification or identifying themselves. LPA interviewed R1 and found that due to visitors being required to wear full PPE, their badge was covered in one incident. R1 stated “there was no stranger in my apartment". R1 further stated “no one comes in except the people I know". Due to conflicting statements, the allegation is determined to be unfounded.

This agency has investigated the complaint alleging building and grounds, facility is retaining a resident with prohibited health conditions, and personal rights. We have found that the complaint was unfounded, meaning that the allegations are false, could not have happened and/or is without a reasonable basis.

SUPERVISOR'S NAME: Carla Martinez	TELEPHONE: (707) 588-5079
LICENSING EVALUATOR NAME: Kimberley Mota	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2021

LIC9099 (FAS) - (06/04)

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