<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 507005604
Report Date: 08/19/2024
Date Signed: 08/19/2024 12:56:51 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/05/2024 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20240605153232
FACILITY NAME:ASTORIA AT OAKDALEFACILITY NUMBER:
507005604
ADMINISTRATOR:JACQUELINE HERNANDEZFACILITY TYPE:
740
ADDRESS:700 LAUREL AVETELEPHONE:
(209) 847-0864
CITY:OAKDALESTATE: CAZIP CODE:
95361
CAPACITY:45CENSUS: DATE:
08/19/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:TIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not change dirty sheets
Staff left resident in dirty clothes
Staff are not following incontinence care plan

INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 8/19/24 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to complete a complaint investigation in to the above listed allegations. LPA Jensen met with Executive Director (ED) Jacqueline Hernandez and explained the purpose of today's visit.

During the course of the investigation LPA Jensen conducted interviews, site inspections, reviewed resident file documentation and photographs. Photographs that were submitted show R1 to have soiled sheets and clothes. During an interview with the ED, she confirmed that R1 was found by their responsible party in soiled clothing and with soiled bedding due to incontinence. It was also confirmed through an interview with the ED that facility staff was experiencing difficulty following R1's incontinence care plan due to R1's behavioral issues which have since been addressed through medical interventions. Based on the interviews conducted and the documents/photographs reviewed the allegations are SUBSTANTIATED. A finding of SUBSTANTIATED means that the preponderance of evidence standard has been met. Deficiencies are being cited pursuant to the California Code of Regulations, Title 22. An exit interview was conducted and copy of this report and appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2024
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/05/2024 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20240605153232

FACILITY NAME:ASTORIA AT OAKDALEFACILITY NUMBER:
507005604
ADMINISTRATOR:JACQUELINE HERNANDEZFACILITY TYPE:
740
ADDRESS:700 LAUREL AVETELEPHONE:
(209) 847-0864
CITY:OAKDALESTATE: CAZIP CODE:
95361
CAPACITY:45CENSUS: DATE:
08/19/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:TIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Due to staff neglect, Residents room smelled Malodorous
Staff do not ensure residents room is cleaned properly
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 8/19/24 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to complete a complaint investigation in to the above listed allegations. LPA Jensen met with Executive Director (ED) Jacqueline Hernandez and explained the purpose of today's visit.

During the course of the investigation LPA Jensen conducted interviews and conducted site inspections on 3 separate occasions. LPA Jensen also reviewed photographic evidence that was submitted anonymously.

Allegation 1: Due to staff neglect, resident room smelled malodorous
LPA Jensen was able to confirm through interviews and record review that Resident 1 was found by their responsible party in clothes soiled from incontinence and bedding soiled by incontinence. It stands to reason that these circumstances likely would result in R1's room being malodorous however there is no evidence to support this event occurred as a result of neglect. It was learned through interview and record review that facility staff was attempting to follow R1's incontinence care plan but were unsuccessful due to
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2024
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 5
Control Number 27-AS-20240605153232
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ASTORIA AT OAKDALE
FACILITY NUMBER: 507005604
VISIT DATE: 08/19/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
behavior issues associated with the progression of disease. The facility has since taken action to implement medical interventions which have remedied the issue. On 3 separate occasions LPA Jensen toured the facility common areas and resident rooms and did not detect any incontinence odors. Based on a lack of evidence to support neglect the allegation is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegation may have happened. The preponderance of evidence does not prove it.

Allegation 2: Staff do not ensure residents room is cleaned properly
During the course of the investigation LPA Jensen inspected resident rooms on 3 separate occasions. All rooms appeared sanitary. LPA Jensen also conducted staff interviews. All staff interviewed consistently stated that rooms are cleaned as needed and deep cleaned weekly. LPA Jensen reviewed photographs of the room for R1 which shows an unsanitary room however there was no evidence to support how long the room was in this state. Based on LPA Jensen's observations, interviews conducted and the lack of evidence to support a violation of regulations the allegation is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegation may have happened. The preponderance of evidence does not prove it.

An exit interview was conducted and a copy of this report and appeal rights were provided.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20240605153232
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ASTORIA AT OAKDALE
FACILITY NUMBER: 507005604
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/19/2024
Section Cited
CCR
87307(a)(3)(C)
1
2
3
4
5
6
7
Personal Accomodations
...the licensee shall assure provision of:
Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads...This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The Licensee has completed in service training related to these matters. No further plan of correction is required.
8
9
10
11
12
13
14
Based on the ED's own admission and photographs taken the resident had soiled bed sheets. This poses a potential risk to the health, safety and personal rights of residents in care.
8
9
10
11
12
13
14
Type B
08/26/2024
Section Cited
CCR
87464(f)(4)
1
2
3
4
5
6
7
Basic services shall at a minimum include:
...Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The Licensee has completed in service training related to these matters. No further plan of correction is required.
8
9
10
11
12
13
14
Based on the ED's own admission and photographs taken the resident was observed wearing soiled clothing. This poses a potential risk to the health, safety and personal rights of residents in care.
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: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20240605153232
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ASTORIA AT OAKDALE
FACILITY NUMBER: 507005604
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/26/2024
Section Cited
CCR
87625(b)
1
2
3
4
5
6
7
Managed Incontinence
...the licensee shall be responsible for the following:
Ensuring that incontinent residents are kept clean and dry...This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The Licensee has completed in service training related to these matters. No further plan of correction is required.
8
9
10
11
12
13
14
Based on ED's own admission and photographs taken R1's incontinence care plan was not followed causing R1 to be in soiled clothing and with soiled bedding. This poses a potential risk to the health, safety and personal rights of residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5