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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803998
Report Date: 09/04/2025
Date Signed: 09/04/2025 03:58:36 PM

Document Has Been Signed on 09/04/2025 03:58 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:OAKMONT GARDENSFACILITY NUMBER:
496803998
ADMINISTRATOR/
DIRECTOR:		KABADI, SANJAYFACILITY TYPE:
740
ADDRESS:301 WHITE OAK DRIVETELEPHONE:
(707) 538-1914
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY: 79CENSUS: DATE:
09/04/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:08 AM
MET WITH:Sanjay Kabadi, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:13 PM
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
Licensing Program Analyst (LPA) Christi Coppo arrived at this facility unannounced, to conduct a Case Management visit. LPA was greeted by concierge. Sanjay Kabadi, Administrator was unavailable but greeted LPA later.

On 7/17/25 LPA issued citations for deficiencies of regulations: Health and Safety Code (HSC)1569.269(a)(6), CCR 87465(h)(5), and CCR 87465(a)(4). The plan of correction for HSC1569.269(a)(6) required facility to submit plan to CCL to conduct personal rights training and training for all direct care staff on prompt call/pendant response times by plan of correction due date. Training to be conducted through facility's chosen vendor, Relias as well as an in-service training by no later than 8/7/25. The plans of correction for deficiencies of CCR 87465(h)(5) and 87465(a)(4) required facility to submit plan to conduct in-service training on pre-pouring medication and medication administration training by plan of correction due date. In-service training to be conducted no later than 8/7/25. Additionally, facility to submit written procedure plan to conduct daily audit of medication closet and medication cart to ensure staff are not pre-pouring medications, by no later than 8/7/25.

On 7/18/25, Health Services Assistant (HSA) Pam Brown submitted required plans for these deficiencies. However, as of today, CCL has not received the in-service training logs nor the Relias training records required for the plan of correction. So, these deficiencies are being re-cited today (deficiencies cited, see 809D).

During visit, LPA found medication room unattended, unlocked, and with medication bubble pack accessible to residents (deficiency cited, see 809D).

Continued on 809C...
NAME OF LICENSING PROGRAM MANAGER: Victoria Bertozzi
NAME OF LICENSING PROGRAM ANALYST: Christi Coppo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 7
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: OAKMONT GARDENS
FACILITY NUMBER: 496803998
VISIT DATE: 09/04/2025
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
Continued from 809...

LPA also observed Centrally Stored Medication closet to contain a rainbow medi-set pillbox with medications present, giving the appearance of pre-pouring. Per LPA interview with Jody Livingston, Health and Wellness director (HWD) facility has stopped pre-pouring. She explained that the medications found were not pre-poured but rather were medications given to the facility by a resident. The pillbox was waiting to be destroyed because the pills were not labeled and it is Oakmont Gardens' policy that any medication not in a pharmacy bottle is not acceptable. HWD emphasized to LPA that in her view, the medication pillbox was not in rotation and was in the overflow section of the medication closet such that they would not be confused with any medications being given to residents. No citation issued today; however, LPA discussed with HWD facility's compliance history with pre-pouring medications and that today's appearance of pre-pouring is out of compliance with regulation. LPA advised that all medications needing to be destroyed should be destroyed immediately. HWD agreed and expressed to LPA that going forward all medications needing to be destroyed will be destroyed immediately.

Additionally, during visit, LPA observed black and white fuzzy substance inside exposed walls in hallway by rooms #113-#116 which appears wet, dark in color, and has the odor of mildew. Insides of walls are exposed as well as some portions of the ceiling, exposing pipes in the wall and in the ceiling. Holes in wall were observed to be on the corner of the hallway by room#116, in the ceiling by room #116 and at the end of the hallway by room #113. Exposed portions of walls are covered by a thin clear piece of film held up by pieces of tape. Exposed portions of ceiling are not covered. LPA observed odor of mildew to be strongest at the end of the hallway by room #113. Black and white fuzzy substance that appears wet and dark in color and has the odor of mildew is accessible to residents and film covering hole does not appear to mitigate any potential airborne health hazards. LPA observed exposed inner portion of wall on the corner by room #116 to have discoloration coming from the appearance of recently being covered with paint (deficiency cited, see 809D). LPA spoke to Asst Maintenance person (S1), who explained to LPA that when railing was installed in this hallway whomever did the installation must have damaged the pipes in the wall in that location because beginning Thursday, 8/29/25 moisture was noticeably collecting and pooling at the bottom of the wall. Once the moisture was observed, facility maintenance cut open the wall to find the leaking pipes, as well as the ceiling. The leak was found and now facility is waiting for plumber to arrive and fix the leaks.

Continued on 809C(2)...
NAME OF LICENSING PROGRAM MANAGER: Victoria Bertozzi
NAME OF LICENSING PROGRAM ANALYST: Christi Coppo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: OAKMONT GARDENS
FACILITY NUMBER: 496803998
VISIT DATE: 09/04/2025
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
Continued from 809C...

While at facility, LPA also followed up on Incident Reports submitted to CCL on 8/29/25 for residents R1, R2, and R3, each of these residents had experienced a fall but refused emergency medical services (EMS). Incident Report for R1, indicated R1 complained of headache but denied hitting their head, R2 was found on the floor face down but also denied hitting their head, and R3 stated they did hit their head.

However, each of these residents refused EMS. LPA discussed incidents with HWD. LPA discussed the importance of getting potential head injuries assessed by a medical professional. LPA explained that it is aresident's right to refuse EMS, but the facility must document each instance of resident refusal. HWD advised LPA that facility does document all resident refusals for EMS. However, HWD could not produce documented refusals for LPA. LPA also discussed with HWD that if a resident has a behavioral expression of cognitive impairment, then best practices are that EMS should be called to assess resident. Additionally, if a residents' family member expresses their wish for EMS not to be called, to maintain compliance with regulation, facility is required to call EMS.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.

Exit interview conducted with Administrator and a copy of this report was given.

NAME OF LICENSING PROGRAM MANAGER: Victoria Bertozzi
NAME OF LICENSING PROGRAM ANALYST: Christi Coppo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 09/04/2025 03:58 PM - It Cannot Be Edited


Created By: Christi Coppo On 09/04/2025 at 01:25 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: OAKMONT GARDENS
FACILITY NUMBER: 496803998

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/05/2025
Section Cited
CCR
87465(h)(5)

1
2
3
4
5
6
7
87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers.
1
2
3
4
5
6
7
Facility to submit plan to conduct in-service training on pre-pouring medication by plan of correction due date 9/5/25. In-service training to be coinducted no later than 9/18/25. Additionally, facility to submit written procedure plan to conduct daily audit of medication closet and medication
8
9
10
11
12
13
14
This requirement not met by licensee as evidenced by: Based on LPA and HWD interview, staff are pre-pouring medications, resulting in medication errors, which poses an immediate health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
cart to ensure staff are not pre-pouring medications, by no later than 9/18/25.
Type A
09/05/2025
Section Cited
CCR87465(a)(4)

1
2
3
4
5
6
7
87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed...(4) The licensee shall assist residents with self-administered medications as needed. This requirement not met by licensee as evidenced by: residents R1, R2, R3, R4, R5, R6, and R7 were
1
2
3
4
5
6
7
Facility to submit plan to conduct 4 hours of medication training via their chosen vendor, Relias by plan of correction due date 9/5/25. Training to be completed by all staff administering medications by no later than 9/18/25.
8
9
10
11
12
13
14
each administered the wrong medication, which poses an immediate health, safety or personal rights risk to persons 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.
Victoria Bertozzi
NAME OF LICENSING PROGRAM MANAGER:
Christi Coppo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2025


LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 09/04/2025 03:58 PM - It Cannot Be Edited


Created By: Christi Coppo On 09/04/2025 at 01:30 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: OAKMONT GARDENS
FACILITY NUMBER: 496803998

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/05/2025
Section Cited
HSC
1569.269(a)(6)

1
2
3
4
5
6
7
ยง1569.269 Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all of the following rights: (6) To care, supervision, and services that meet their individual needs...
This requirement not met by licensee as
1
2
3
4
5
6
7
Facility will submit plan to CCL to conduct personal rights training and training for all direct care staff on prompt call/pendant repsonse times by plan of correction due date 9/5/25. Training to be conducted through facility's chosen vendor, Relias as well as an in-service training by no later than 9/18/25.
8
9
10
11
12
13
14
evidenced by: R1 waited in excess of 33 minutes for staff response after activating pendant alert for assistance, which poses an immediate health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
Type A
09/05/2025
Section Cited
CCR87465(h)(2)

1
2
3
4
5
6
7
(h)The following requirements shall apply to medications which are centrally stored: (2)Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication
1
2
3
4
5
6
7
Facility to submit plan to conduct in-service medication training focused on proper storage of medications and ensuring inaccessibility of medication by plan of correction due date 9/5/25. Training to be completed by all staff administering medications by no later than 9/18/25.
8
9
10
11
12
13
14
This requirement not met by licensee as evidenced by: based on LPA observation medication room left unattended, door unlocked, and with medications accessible to residents, which poses an immediate health, safety or personal rights risk to persons 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.
Victoria Bertozzi
NAME OF LICENSING PROGRAM MANAGER:
Christi Coppo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2025


LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 09/04/2025 03:58 PM - It Cannot Be Edited


Created By: Christi Coppo On 09/04/2025 at 01:37 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: OAKMONT GARDENS
FACILITY NUMBER: 496803998

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/05/2025
Section Cited
CCR
87303(a)

1
2
3
4
5
6
7
(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 requirement not met by licensee as evidenced by:
1
2
3
4
5
6
7
Facility to submit written plan of how facility will ensure the health and safety of residents that are exposed to hallway that has exposed inner parts of wall that has black and white fuzzy substance that appears wet and dark in color and has the odor of mildew, by plan of correctiond due date.
8
9
10
11
12
13
14
Based on LPA observation, black and white fuzzy substance that appears wet and dark in color and has the odor of mildew, found inside exposed walls in hallway by rooms #113-#116, which poses an immediate health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
LPA will review plan and if plan is in compliance with regulation, then facility will implement plan and have plan completed no later than 9/18/25

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.
Victoria Bertozzi
NAME OF LICENSING PROGRAM MANAGER:
Christi Coppo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2025


LIC809 (FAS) - (06/04)
Page: 7 of 7