496803998-9-8-2022-21-AS-KMOA-CJAPEQ-20220915111532

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803998
Report Date: 09/08/2022
Date Signed: 09/08/2022 10:51:35 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/29/2022 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20220429160955

FACILITY NAME:	OAKMONT GARDENS		FACILITY NUMBER:	496803998
ADMINISTRATOR:	SORIANO, MARIELE		FACILITY TYPE:	740
ADDRESS:	301 WHITE OAK DRIVE		TELEPHONE:	(707) 921-1861
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95409
CAPACITY:	79	CENSUS: 131	DATE:	09/08/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Gloria Albor		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Facility failed to meet residents care needs
Staff do not assist resident with incontinence care

INVESTIGATION FINDINGS:

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Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on this complaint. LPA met with Gloria Albor and discussed the complaint. It has been alleged that staff have not assisted R1 with hygiene and bathing as outlined in R1's care plan. This investigation has included site visits; document reviews; and statements from witnesses. The following determinations are made: R1 requires assistance with showering and hygiene; Most staff who could comment on R1's care at the time this complaint was received are no longer in the employ of the facility; Until very recently, shower logs and care notes addressing hygiene for residents were not maintained by the facility; Existing staff have indicate that R1 has often exercised R1's right to refuse bathing and assistance from staff, although new approaches by staff to gain cooperation from R1 with these issues have resulted in increased results in meeting R1's needs for assistance with activities of daily living. Although the allegations may be true, or valid, based upon the reviews and statements, there is not a preponderance of evidence to prove the allegations true or, not true. Therefore, the allegations are UNSUBSTANTIATED.
Report left. No citations issued.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Carla Martinez	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David Leibert	TELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/29/2022 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20220429160955

FACILITY NAME:	OAKMONT GARDENS		FACILITY NUMBER:	496803998
ADMINISTRATOR:	SORIANO, MARIELE		FACILITY TYPE:	740
ADDRESS:	301 WHITE OAK DRIVE		TELEPHONE:	(707) 921-1861
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95409
CAPACITY:	79	CENSUS: 131	DATE:	09/08/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Gloria Albor		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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9

Staff mismanaged resident’s medication
Medication management is inadequate

INVESTIGATION FINDINGS:

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Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings
on this complaint. LPA met with Gloria Albor and discussed the findings. According to Facility’s
UNUSUAL INCIDENT/INJURY REPORT dated 1/31/2022 submitted by Director of Health Services,
R1 was sent to ER on 1/30/2022 due to low blood pressure. A medication audit found that from
1/26 through 1/30/2022 R1 was administered medication by facility staff that had been
discontinued by physician which caused R1’s blood pressure to fall. This Department’s
investigation, consisting of documents reviews and statements, confirms the report and found
that R1’s medications were mismanaged and that R1 was administered multiple medications
which had been discontinued by physician and resulted in R1’s hospitalization. Based upon
these reviews and statements, the preponderance of evidence standard has been met.
Therefore, the allegations are SUBSTANTIATED. The following deficiencies were observed (see
LIC 9099D) and cited from the California Code of Regulations, Title 22, Division 6 of California
Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month
period may result in civil penalties. Exit interview conducted and appeal of rights provided.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Carla Martinez	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David Leibert	TELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

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 21-AS-20220429160955

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: OAKMONT GARDENS	FACILITY NUMBER: 496803998
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/08/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/08/2022 Section Cited CCR 87465(c)(2)	1 2 3 4 5 6 7	87465(c)(2) Incidental Medical and Dental Care. Once ordered by the physician the medication is given according to the physician's directions. ***Based on statements and records, this requirement has not been met as evidenced by: R1 was given medications that had been ordered discontinued by physician.	1 2 3 4 5 6 7	Cleared at time of visit. Facility has done a medication audit, implemented an electronic MARS system, and provided additional training to staff administering medications, implemented a review process with outside provider.
	8 9 10 11 12 13 14	This posed an immediate risk to the health of R1	8 9 10 11 12 13 14	*THIS IS AN AMENDED VERSION OF AN ORIGINAL DOCUMENT***
Type A 09/08/2022 Section Cited CCR 87464(f)(1)(c)	1 2 3 4 5 6 7	87464(f)(1)(c) Basic Services. "Care and supervision" means the facility assumes responsibility for...Assistance includes assistance with taking medications, money management, or personal care. ***Based on statements and records, this requirement has not been met as evidenced by: R1 was given medications	1 2 3 4 5 6 7	Cleared at time of visit. Facility has done a medication audit, implemented an electronic MARS system, and provided additional training to staff administering medications, implemented a review process with outside provider.
	8 9 10 11 12 13 14	that had been discontinued by physician. This posed an immediate risk to the health of R1.	8 9 10 11 12 13 14

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: Carla Martinez	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David Leibert	TELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022

LIC9099 (FAS) - (06/04)

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