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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315002955
Report Date: 04/02/2025
Date Signed: 04/02/2025 10:48:30 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
08/23/2024 and conducted by Evaluator Cassandra Mikkelson
COMPLAINT CONTROL NUMBER: 59-AS-20240823174553
FACILITY NAME:OAKMONT OF WESTPARKFACILITY NUMBER:
315002955
ADMINISTRATOR:THOMAS, HALEYFACILITY TYPE:
740
ADDRESS:2400 PLEASANT GROVE BLVD.TELEPHONE:
(916) 545-8904
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:142CENSUS: 104DATE:
04/02/2025
UNANNOUNCEDTIME BEGAN:
10:32 AM
MET WITH:Barbara Fleck, AdministratorTIME COMPLETED:
10:55 AM
ALLEGATION(S):
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Staff did not keep the facility clean, sanitary and free from odor
Staff did not report a change in resident's condition
INVESTIGATION FINDINGS:
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Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Executive Director to deliver findings for the above complaint allegations.

During the investigation, LPA conducted interviews, conducted a tour of the facility, and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

***Report continued on 9099-C***
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025
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 59-AS-20240823174553
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: OAKMONT OF WESTPARK
FACILITY NUMBER: 315002955
VISIT DATE: 04/02/2025
NARRATIVE
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Staff did not keep the facility clean, sanitary and free from odor

The department investigated allegation, “Staff did not keep the facility clean, sanitary, and free from odor. LPA interviewed staff, relevant parties, witnesses, and reviewed facility records. Interviews indicated that R1’s room had strong smells of urine. LPA interviewed care staff in which they stated resident was incontinent and would have accidents. Care staff stated they would clean resident and residents’ room and give R1 showers when needed. LPA interviewed R1’s family in which they stated they observed R1’s bathroom being unclean and R1’s bathroom having a smell of urine to it. LPA interviewed a witness, and they stated resident’s room smelled strongly of urine and was unclean. LPA observed on outside agency documentation that resident bed was unclean and window had to be opened due to the smell. Based on interviews conducted and observations, staff did not ensure the facility was kept sanitary and odor free.

Staff did not report a change in resident's condition.

The department investigated allegation, “Staff did not report a change in resident’s condition”. LPA interviewed staff, relevant parties, witnesses and reviewed facility, and hospice records. Interviews indicated R1 lost 30 pounds between the month of March 2024 to June 2024. Facility did not report weight loss to R1’s primary care physician or responsible party. LPA interviewed facility staff in which they stated they did not observe R1 having wight loss during their stay at the facility. Interviews with the memory care director indicated staff weigh residents monthly and will report changes to doctor and responsible party if necessary. Memory care director stated there was nothing significant to report to family. LPA reviewed hospice documents in which it states R1 weighed 206 pounds in January 2024 and her last recorded weight in June 2024 was 176 pounds. R1 lost 30 pounds in 6 months. Based on information obtained, R1 was found to have lost 30 pounds in 6 months and facility did not report the change to R1’s primary care physician or R1’s responsible party.

Based on the information obtained for the allegations above, the allegations are SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Exit interview conducted with Executive Director and a copy of the report and appeal rights was provided.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20240823174553
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: OAKMONT OF WESTPARK
FACILITY NUMBER: 315002955
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/02/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
04/30/2025
Section Cited
CCR
87303(a)
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87303(a) Maintenance and Operation (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This poses a potential health and safety risk to the residents in care.
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Facility will conduct a staff training and submit training information/proof to LPA by POC due date.
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This requirement is not met as evidenced by: Based on interviews conducted, staff did not ensure that R1’s room was free of odor and kept clean and sanitary.
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Request Denied
Type B
04/30/2025
Section Cited
CCR
87466
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87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning… When changes such as unusual weight gains or losses… are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person... This poses a potential health and safety risk to the residents in care.
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Facility will conduct a staff training and submit training information/proof to LPA by POC due date.
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This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, facility did not report changes in R1’s weight to the responsible party or medical professional.
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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: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3