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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201085
Report Date: 11/04/2024
Date Signed: 11/04/2024 05:00:37 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/05/2024 and conducted by Evaluator Lisha Holmes
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240705101641
FACILITY NAME:OAKMONT OF CONCORDFACILITY NUMBER:
079201085
ADMINISTRATOR:SOR, KIM SFACILITY TYPE:
740
ADDRESS:1401 CIVIC COURTTELEPHONE:
(925) 798-4004
CITY:CONCORDSTATE: CAZIP CODE:
94520
CAPACITY:121CENSUS: 89DATE:
11/04/2024
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:San Sor, Executive DirectorTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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9
Staff retaliate against residents in care.

Licensee does not ensure that a portion of resident council meetings are conducted without the presence of facility staff.
INVESTIGATION FINDINGS:
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On 11/04/24 around 03:30 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to deliver the complaint findings for the above allegations. LPA met with San Sor, Executive Director (ED) and explained the purpose of the visit.

During the course of the investigation LPA interviewed ED, Staff and Residents. LPA requested emails and other forms of communication that were sent to residents and responsible parties regarding Assisted Living (AL) pendant system and Memory Care (MC) call button; the documentation to include any communications that show the request for repairs and when repairs were completed for any outages. LPA requested Resident Roster, Staff Roster, current LIC 500 and LIC 500 dated 06/2024, Resident Council's agenda/minutes for 05/2024 and 06/2024, In-Service trainings, and Resident Council President's contact information.

Continued on LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024
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 2
Control Number 15-AS-20240705101641
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: OAKMONT OF CONCORD
FACILITY NUMBER: 079201085
VISIT DATE: 11/04/2024
NARRATIVE
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...Continued from LIC9099.

Allegations: UNSUBSTANTIATED
Staff retaliate against residents in care.
Licensee does not ensure that a portion of resident council meetings are conducted without the presence of facility staff.

Interviews with Staff (S2, S3, S4, S5, S6) and Residents (R1, R2, R3, R11) revealed that no one was aware of any forms of retaliation against residents. R3 stated that people expressed they were worried about retaliation, but R3 never experienced retaliation or heard any grievances about how the resident council meeting were conducted. The President of the Resident Council and ED confirmed the meetings would be conducted with Staff and Residents, and toward the end of the meetings the ED would adjourn for residents to consult with one another and return to conclude the meeting. Based on the information obtained the above allegations are UNSUBSTANTIATED.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2