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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347005427
Report Date: 12/18/2024
Date Signed: 12/18/2024 12:27:58 PM

Unsubstantiated


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
11/19/2024 and conducted by Evaluator Cassandra Mikkelson
COMPLAINT CONTROL NUMBER: 59-AS-20241119170352
FACILITY NAME:OAKMONT OF FOLSOMFACILITY NUMBER:
347005427
ADMINISTRATOR:CLYMO, MICHAELFACILITY TYPE:
740
ADDRESS:1574 CREEKSIDE DRTELEPHONE:
(916) 817-4500
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:88CENSUS: 71DATE:
12/18/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Michael ClymoTIME COMPLETED:
12:35 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff mismanaged client’s medication
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensed Program Analysts (LPAs) Cassandra Mikkelson and Kevin Mknelly arrived at the facility unannounced and met with Executive Director Michael Clymo to deliver findings for the above complaint allegation.

During the investigation, LPAs 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 ***
Unsubstantiated
Estimated Days of Completion: 15
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
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 59-AS-20241119170352
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 FOLSOM
FACILITY NUMBER: 347005427
VISIT DATE: 12/18/2024
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
During multiple visits conducted at the facility, LPAs observed resident’s medication MARs to be complete with no errors indicated. LPAs observed medication room to be clean and organized.

Interviews conducted with staff members S1, S2, S3, S4, S5, and S6 indicated that they have not witnessed any mismanagement of resident medications. Interviews with thirteen (13) residents indicated that they have never received the wrong medication or not been given the correct dosage of their medications.

Based on interviews conducted and observations, the preponderance of evidence standards have not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. Findings that the complaint is Unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview was conducted with Michael Clymo. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2