OAKMONT OF NOVATO

Official classification

Type A

Official code

87705(d)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia:(d) The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement, as defined in Section 87101, Definitions. This requirement is not met as evidenced by: Based on records reviewed and interviews conducted, Licensee did not ensure staff were aware when R1 left the building without assistance, This poses an immediate Health, Safety or Personal Rights risk to persons in care.

Official plan of correction

Facility conducted an elopement training for AM and PM shift on 4/29/2026. Licensee to ensure NOC shift receives elopement training with training topic, date, and signatures included. Training to be submitted to CCL by 05/15/2026.

Deadline recorded: May 15, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by Based on observation and document review, the licensee did not comply with the section cited above as R2 slapped R1 in the face which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee to conduct training for all care staff regarding personal rights of residients. Licensee to provide scheduled training date to CCL by POC due date of 12/29/2025. Licencee to submit proof of completed training for all care staff to CCL by POC due date 01/07/2026.

Deadline recorded: Jan 7, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c) The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above. 7 out of 8 staff members did not have current first aid certification on file, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/17/2025 Plan of Correction Licensee to submit proof of scheduled training with vendor for First-Aid/CPR certification for S1, S2, S3, S4, S5, S6, and S7. Licensee to provide training date to CCL by POC due date, 04/17/2025. Licensee to submit proof of First-Aid/CPR certificates to CCL by 04/25/2025.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411(a) Personal Requirements - General Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidence by: Based on incident report and interview, facility failed to provide supervision to R1 resulting in an elopement. The absense of supervision is an immediate risk to the Health, Safety and Rights of resident in care.***A Civil Penalty of $500.00 is being assessed.

Official plan of correction

Cleared at time of visit. Facility conducted an in-service training about elopement procedures and has been completed for all staff in the community.

Deadline recorded: Nov 14, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

15630

Regulation authority

CCR

What the official deficiency says

W & I 15630(a) Elderly and Dependent adult abuse mandated reporting. Telephone and written report must be completed in compliance with time frames required by law. Based upon interviews and document review, this requirement has not been met as evidenced by: Upon obtaining knowledge of suspected physical abuse of residents by a staff person on and before 4/12, facility staff did not make required reports within 24 hours as required. This posed an immediate risk to the health and safety of residents in care.

Official plan of correction

Cleared at time of visit. Facility management has provided additional training to staff on the topic of required reporting.

Deadline recorded: Aug 29, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in that LPAs observed a residents bed sheets to be wet and having an incontinence odor throughout the Memory Care unit which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/05/2024 Plan of Correction Admin agrees to submit a plan to keep facility free from Incontinence odors and submit to CCL by POC due date of 7/5/24

Official classification

Type A

Official code

87705(j)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (j)The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This requirement was not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above by staff not responding to the auditory device on exit door in Memory Care Unit, allowing a resident to elope.

Official plan of correction

Facility conducted a staff retraining, increased supervision was implemented, and a 1:1 companion has been put in place for resident. Proof to be provided to LPA by POC due date of 12/28/2023.

Deadline recorded: Dec 28, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require…(1) A written report shall be submitted to the licensing agency & person responsible for the resident within 7 days of the occurrence of any of the events…(B) Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision. This requirement has not been met as evidence by: Based on LPA’s records review and interviews conducted Administrator did not ensure that CCL was notified of incidents involving R1 and R7, which poses a potential health & safety risk to residents in care.

Official plan of correction

Administrator to ensure all incidents that threaten the safety of residents are reported to CCL per regulation. Signed statement that the regulation was reviewed and sign in sheet for all staff trained to be submitted by POC due date.

Deadline recorded: Oct 27, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.69(a)(1)

Regulation authority

HSC

What the official deficiency says

§1569.69 Employees assisting residents with self-administration of medication; training requirements (a) Each RCFE licensed under this chapter shall ensure...the following training requirements: (1)...the employee shall complete 16 hours of initial training. This training shall consist of eight hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and eight hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. This requirement is not met as evidenced by: Based on record review & interview, the licensee did not comply with the section cited above in 2 out of 6 staff which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Facility to submit written plan for all staff training including medication prior to assist with medications to ensure that staff has required training by POC due date.

Deadline recorded: Oct 27, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(a)(1)

Regulation authority

CCR

What the official deficiency says

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. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA/Administrator observations, the licensee did not comply with the section cited above in bathroom located at room#124 needed assistance, toilet and bathroom floor have feces on it, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/30/2023 Plan of Correction Administrator will submit a written statement in how the facility staff will ensure compliance with regulation by POC due date to clear the citation.

Official classification

Type A

Official code

87355(e)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA/Administrator observation, records review and interview with Administrator did not ensure to obtain a criminal record clearance for staff (S9) prior to work, reside or provide care to residents in care which poses an immediate health, safety and personal rights risk to residents in care. ***Civil Penalty is being assesed for the amount of $100 per day.

Official plan of correction

POC Due Date: 06/30/2023 Plan of Correction Administrator associated staff (S9) as required by law. Administrator will submit a self-certification that S9 was transferred and associated to the facility to CCL by POC due date.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA/Administrator observation, interview and record review, the facility staff did not comply with the section cited above in 1 out of 10 resident's diagnosed with Dementia medical assessments was performed within the last 12 months as indicated per regulation, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/14/2023 Plan of Correction Administrator agreed to provide evidence through self-certification of current medical assessments for 1 resident to CCL by POC due date.

Official classification

Type B

Official code

87218(a)(1)

Regulation authority

CCR

What the official deficiency says

87218(a)(1) Theft and Loss. The initial personal property inventory shall be completed by the licensee, and the resident, or the resident’s representative. *** Based upon statements and file research, this requirement has not been met as evidenced by: On or about April 06, 2023, facility staff were unable to produce the inventory for R1’s personal property. This posed a potential risk to the personal rights of R1.

Official plan of correction

Administration will review the requirements of 87218(a)(1) and provide additional training to all staff providing intake to new residents. Proof of training to be submitted to CCL by POC date in order to clear the deficiency.

Deadline recorded: Jun 15, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87208(a)

Regulation authority

CCR

What the official deficiency says

87208(a) Plan of Operation. Each facility shall have... a current, written .. plan of operation. The plan.. shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval…***Based on statements and documents, this requirement not met as evidenced by: Facility did not follow Facility’s Loss policies in response to R1’s missing glasses and hearing aids. This posed a potential risk to personal rights of R1.

Official plan of correction

Administration will review 87208 and provide additional training to staff who deal with residents’ property concerns and will proceed with their stated policy regarding R1’s missing property. Proof of training and copy of Facility’s investigative report to be submitted Report to be submitted to CCL by POC date in order to clear the deficiency.

Deadline recorded: Jun 15, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(5)

Regulation authority

CCR

What the official deficiency says

***Amended…87465 (a)(5) Incidental Medical and Dental Care Services. The licensee shall assist residents with self-administered medications when needed. This requirement is not met as evidenced by: ***Amended…Based on incident report of 3/4/23 and interviews conducted with facility staff. Facility failed to administer medication per physician’s orders which poses an immediate health and safety risk to clients in care.

Official plan of correction

Administrator to ensure that all residents receive their medication as prescibed by their physician. Administrator has taken disciplinary action and provided retraining to Staff. . ***Amended…civil penalties issued on 4/6/2023 was dismissed.

Deadline recorded: Apr 7, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

80075(b)

Regulation authority

CCR

What the official deficiency says

80075(b) Health Related Services. Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. This requirement is not met as evidenced by: Based on incident report of11/26/22 and interview withmedical staff at facility, S1 failed to ensure that resident received the right dosage of medication as prescribed by physician which poses an immediate health and safety risk to clients in care.

Official plan of correction

Administrator/Licensee to ensure that all clients receive their medication as prescibed by their physician. Administrator has taken disciplinary action and provided retraining to Staff. Additionally, continuing a training on 1/26/23. A list of attendees and training materials will be submitted to LPA by 1/28/23. A

Deadline recorded: Jan 19, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

Storage Space. Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. ***Based on LPA observation this requirement has not been meet as evidenced by: finger nail polish remover was observed in bathroom of memory care apartment bathroom which was accessible to residents in care. This poses an immediate risk to the health of the residents.

Official plan of correction

Director will provide refresher training to MC staff and will provide proof to CCL by POC date in order to clear the deficiency.

Deadline recorded: Jan 18, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(g)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements (g) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall.... This requirement is not met as evidenced by: Based on document review 1 staff have not been fingerprinted and 3 staff have not been associated which poses an immediate risk to the health, safety, personal rights for residents in care.

Official plan of correction

Facility to have all staff fingerprinted and cleared prior to having staff returning to work. Facility to submit self-certification that all staff will be be fingerprint-cleared and associated to faciity by POC due date of 12/23/22.

Deadline recorded: Dec 23, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

87458(a) Medical Assessment. Prior to accepting a person as a resident the licensee must obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. ** This requirement was not met. Based on LPAs record review he facility failed to ensure Residents (R1-4) had submitted a completed medical assessment, within the last year. R1 -R4 did not sign Physician's Report which poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee agrees to review resident records and make sure they are complete and signed by POC due date of 11/01/2022.

Deadline recorded: Oct 20, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements. This requirement is not met as evidenced by: Based on records reviewed, interview, facility didn't comply w/section cited above within 2 of2 residents incident reporting which poses a potential risk to their health, safety, personal rights for residents in care. Resident R1 and R2 had incidents that occurred on 7/22/22 & 8/3/22 which were not submitted to the department. (see docs, LIC 809)

Official plan of correction

Facility to provide training to designated reporting staff to ensure that all incidents that need to be reported will be reported according with Title 22 Regulation. Facility to submit Department with proof of training, staff signatures , date , time and what was covered in addition to self certification that facility undestands this regulation by POC due date of 10/13/22.

Deadline recorded: Oct 13, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(b)(2)

Regulation authority

CCR

What the official deficiency says

87705(b)(2)Care of Persons with Dementia - Safety measures to address behaviors such as wandering.This requirement isn't met as evidenced by:Based on interviews,SIR & physician's report R1 eleoped w/out staff knowledge on 7/30/22 the facility didn't comply w/section above to address behaviors such as wandering for resident R1 which poses an immediate Health, Safety risk to residents in care. (see copies)

Official plan of correction

Facility agreed and conducted in-service staff training regarding elopment and have facility elopement policies and procedures reviewed and in place. Both have been handled to CCLD on 8/2/2022. POC cleared

Deadline recorded: Aug 4, 2022. A deadline is not proof that correction was completed.