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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201085
Report Date: 03/20/2026
Date Signed: 03/20/2026 04:54:58 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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
07/10/2025 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20250710094801
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: 90DATE:
03/20/2026
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Executive Director, San SorTIME COMPLETED:
05:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are mismanaging resident's medications.
Staff are not reporting incidents to proper agencies.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 3/20/2026, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to continue the complaint investigation and deliver findings. LPA met with Executive Director, San Sor and explained the purpose of the visit.

During the course of the investigation LPA reviewed records including but not limited to charting notes, unusual incident reports (UIR's),physicians reports, and correspondences.

Report continues on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2026
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
Control Number 15-AS-20250710094801
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: OAKMONT OF CONCORD
FACILITY NUMBER: 079201085
VISIT DATE: 03/20/2026
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
On the allegation "Staff are not reporting incidents to proper agencies." LPA reviewed charting notes and available unusual incident reports for R1. Based on a review of charting notes LPA identified over 35 incidents between March 2025 and November 2025 that required submitting an unusual incident report and/or SOC341 report of suspected abuse to the required parties and agencies. LPA observed that the facility submitted 1 unusual incident reports and 5 SOC341 report of suspected abuse during this time period. LPA observed that all required incidents where not reported as required by Title 22 therefore the allegation "Staff are not reporting incidents to proper agencies." is Substantiated.

On the allegation "Staff are mismanaging resident's medications." LPA reviewed R1's MAR, charting notes, and correspondences with R1's physician and responsible party. LPA identified 9 occasions where R1 was administered their as needed PRN for agitation. R1 was a memory care resident and was unable to determine their need for the PRN and unable to communicate their symptoms clearly. LPA observed that there was not a record of the Facility staff contacting the resident's physician prior to each dose, describing the resident's symptoms, and receiving direction to assist the resident in self-administration of that dose of medication as required by Title 22 therefore the allegation "Staff are mismanaging resident's medications." is Substantiated.

Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.

Exit interview conducted with Executive Director, San Sor. Appeal rights and copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 15-AS-20250710094801
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: OAKMONT OF CONCORD
FACILITY NUMBER: 079201085
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/20/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/27/2026
Section Cited
CCR
87211(a)(1)(D)
1
2
3
4
5
6
7
(a) Each licensee shall furnish...but not limited to, the following:(1)A written report shall be submitted... within seven days of the occurrence of any of the events specified in (A) through (D) below...(D) Any incident which threatens the welfare, ...of any resident.

This requirement was not met as evidence by:
1
2
3
4
5
6
7
By POC facility agrees to conduct a refresher course on reporting requirements for all staff and notify CCLD.
8
9
10
11
12
13
14
Based on record review of R1's charting notes and available UIR's the facility did not report all incidents as required. LPA identified over 35 reportable incidents and observed that the facility only had record of reporting 6 incidents which posed a potential safety and personal rights risk to residents in care.
8
9
10
11
12
13
14
Type B
03/27/2026
Section Cited
CCR
87465(d)
1
2
3
4
5
6
7
(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration provided all of the following requirements are met:
1
2
3
4
5
6
7
By POC facility agrees to conduct a refresher course on incidental medical and dental care for all staff administering medications and notify CCLD.
8
9
10
11
12
13
14
Based on record review of R1's charting notes and correspondenses with their physician LPA identified at least 9 times R1 was administered their PRN but was unable to identify any instances where the physician was contacted prior and all of the requirements were met for administering a PRN to a resident who can not determine their need or communicate their symptoms which posed a potential health and personal rights risk to 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.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3