Oakmont of San Antonio Heights

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Paola Guerrero made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Facility Administrator Cheryl Stevenson and was granted entry to the facility. The facility is a Residential Care Facility for Elderly (RCFE) Licensed capacity is (140) current census (84). LPA was accompanied by Facility Administrator, to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected residents’ bedrooms; they are equipped with required furniture such as mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. Medications are kept inside MedRoom inaccessible to residents in care. Overall, the facility is clean, in good repair, and operates in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed six (6) resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed four (4) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Medications were audited at random and appeared to be dispensed appropriately by staff members. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Facility Administrator Cheryl Stevenson.the state’s words, verbatim · CDSS document, Jul 9, 2026

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced Case Management Incident visit on 6/12/2026. LPA met with Facility Administrator Cheryl Stevenson and explained the reason for the visit. The visit is in response to Staff #1 inappropriately touching Resident #1. During the visit, LPA conducted interviews with staff #2 and Staff #3 regarding the incident involving Resident #1 and Staff #1. Staff #2 and Staff #3 informed LPA that Resident #1 reported to staff that Staff #1 had inappropriately touched Resident #1. Staff #2 and Staff #3 informed LPA that staff reported the incident to the required agencies and filed a police report. Staff #2 and Staff #3 further indicated that on 2/2/2026 Staff #1 was suspended pending investigation. Staff #2 and Staff #3 reported to LPA that Sheriff department interviewed Staff #1 who denied the allegation of inappropriately touching Resident#1. Staff #2 and Staff #3 informed LPA that Sheriff Department interviewed Resident #1 who reported to the department that the resident does not wish to pursue legal action against Staff #1. During review of record LPA observed that Deputy Sheriff T Esposito responded to the incident and provided the facility with Case Number FN 260350039. Staff informed LPA that the Sheriff Department informed staff that based on interviews the department found no wrongdoing from Staff #1. During the time of the visit LPA could not interview Resident #1 being that Resident #1 was out on vacation. LPA collected copies pertinent to the allegation. During today's visit, no red flags were observed, and no deficiencies were cited regarding this incident. An exit interview was conducted, and a copy of this report was provided to Facility Administrator Cheryl Stevenson.the state’s words, verbatim · CDSS document, Jun 12, 2026

Allegation investigated: Staff did not provide adequate supervision, resulting in resident sustaining a fracture

Licensing Program Analyst (LPA) Paola Guerrero arrived at the facility to deliver investigative findings. LPA met with Facility Health Services Director and explained the purpose of the visit regarding the allegations listed above. First allegation: Staff did not provide adequate supervision, resulting in resident sustaining a fracture. Regarding the allegation stated above, LPA conducted a review of records pertaining to Resident #1 throughout the review of records LPA discovered that Resident #1 was not classified as a fall-risk. In addition, throughout record review LPA discovered that during Resident #1 fall Resident #1 was assisting Resident 2 in the shower and due to the assistance Resident #1 was providing to Resident #2 led Resident #1 to sustain a fall which resulted in Resident #1 to sustain an elbow fracture. During review of records LPA discovered that Resident # 1 did not have a history of frequent falls. LPA conducted an interview with Facility Health Services Director who informed LPA that the facility had Reported to Resident #1 and resident’s family, about the concerns regarding Resident #1 providing care to Resident #2. Unsubstantiated Health Services Director informed LPA that Resident #1 was informed by the staff and the family not to assist Resident #2 with care. LPA conducted an interview with Resident #1 responsible party which they informed that Resident #1 was aware not to be providing care to Resident #2, and the result of that fracture was due to Resident # 1 not asking staff for assistance and continuing to provide care to Resident #2. Based on corroborating evidence the department has determined that the above allegations are Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Administratorthe state’s words, verbatim · CDSS document, Feb 20, 2026 · control 56-AS-20251107091354

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Paola Guerrero arrived at the facility to deliver findings on complaint number 56-AS-20251107091354. This case management visit is in response to complaint number 56-AS-20251107091354. LPA met with Health Services Director Brandy Herrera and explained the purpose of the visit. LPA explained to Brandy that a deficiency will be issued to the facility in relation to complaint control number 56-AS-20251107091354. During the review of records LPA observed that Resident #2 had sustained multiple falls on different occasions. During further review LPA discovered that the only report reported to CCL was the fall that involved Resident #1 and Resident # 2, sustaining a fall in the shower that resulted in Resident #1 with an elbow fracture. During interview with Facility Health Services Director LPA was informed that falls pertaining to Resident #2 were not reported to CCL because Resident #2 did not need medical attention. During review of records LPA discovered that Resident #2 was a fall risk. In addition, LPA found that Resident #2 had count of notes that were made regarding Resident #2 sustaining falls which were not reported to CCL. LPA informed Facility Health Services Director that all incidents involving residents whether they were transported to the hospital or just administered first aid, that the facility must report. LPA will be issuing a deficiency for reporting requirements in relation to complaint control number 56-AS-20251107091354.the state’s words, verbatim · CDSS document, Feb 20, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Mar 6, 2026

Reporting Requirements 87211...(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: ...(1) ...A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident’s name, age, sex and date of admission; date an nature of the event; attending physician’s names, findings, and treatment, if any; and disposition of the case. This requirement is not me as evidence by: Based on interviews, and record review, the licensee did not follow reporting requirements for resident #1, which poses a potential Health, Safety, or Personal Rights risk to Residents in care.the state’s words, verbatim · CDSS document, Feb 20, 2026

Plan of correction: The Licensee has agreed to read over regulation “Reporting Requirements (a)(1)”. The licensee has agreed to provide training to staff regarding reporting requirements. The Licensee will email LPA a copy of the training by POC due date of 3/6/2026.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Paola Guerrero made an unannounced visit to the facility. LPA arrived at the facility on 1/30/2026 to conduct a case management visit to follow up on possible financial abuse. LPA met with Facility Administrator Cheryl Stevenson and explained the purpose of today's visit. This case management visit consisted of collecting pertinent documentation and conducting staff interviews regarding possible financial abuse. LPA interviewed Staff #1 for further information regarding suspected financial abuse of Resident #1 and the events that led up to the incident. Staff #1 informed LPA that after learning about the incident the facility took disciplinary action against Staff #2 and suspended Staff#2. Staff #1 informed LPA that the facility also contacted their local Sheriff Department and reported the incident. Staff #1 informed LPA that while Staff #2 was on suspension pending investigation Staff #2 resigned on 1/5/2026. Staff #1 informed LPA that local Sheriff Department informed the administrator that no crime/or theft had occurred due to the fact that Resident#1 had indicated that the money was given to Staff #2 as a gift. During review of records LPA discovered that R#1 manages their own cash resources and finances. No deficiencies were cited during this visit. An exit interview was conducted where this report (LIC 809) was discussed and provided to Facility Administrator Cheryl Stevenson.the state’s words, verbatim · CDSS document, Jan 30, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Paola Guerrero made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Facility Administrator Cheryl Stevenson and was granted entry to the facility.The facility is a Residential Care Facility for Elderly (RCFE) Licensed capacity is (140) current census (86). LPA was accompanied by Facility Administrator, to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. Medications are kept inside Med-Room inaccessible to residents in care. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed five (5) resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed five (5) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Medications were audited at random and appeared to be dispensed appropriately by staff members. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Facility Administrator Cheryl Stevenson.the state’s words, verbatim · CDSS document, Oct 20, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Paola Guerrero and Beena Singh made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPAs met with Facility Administrator Cheryl Stevenson and was granted entry to the facility.The facility is a Residential Care Facility for Elderly (RCFE) Licensed capacity is (140) current census (95). LPAs was accompanied by Facility Administrator, to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPAs inspected resident’s bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPAs observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. Medications are kept inside Med-Room inaccessible to residents in care. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPAs reviewed six (6) resident files for admission agreements, updated physician reports, and needs and services plans. LPAs also reviewed seven (7) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Medications were audited at random and appeared to be dispensed appropriately by staff members. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Facility Administrator Cheryl Stevenson.the state’s words, verbatim · CDSS document, Sep 18, 2024

Allegation investigated: Staff does not answer residents' call buttons in a timely manner due to inadequate staffing. Staff does not ensure resident's showering needs are being met. Staff does not ensure resident's restroom needs are being met. Staff is overcharging residents for services not received.

Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Administrator Cheryl Stevenson and explained the purpose of the visit. The investigation consisted of interviews and review of records. First allegation, Staff does not answer residents' call buttons in a timely manner due to inadequate staffing. During interviews and review of records LPA observed Resident#1 history alerts which displayed staff to be answering Resident#1 alerts on a timely manner. In addition, LPA obtained facility roster and observed that facility has adequate staffing for every shift to meet resident’s needs. Second allegation, Staff does not ensure resident's showering needs are being met. During interviews and review of records LPA observed that Resident #1 showering needs are being met. LPA conducted interviews with residents which all stated that their showering needs are being met. Unsubstantiated Third allegation, Staff does not ensure resident's restroom needs are being met. During interviews and review of records LPA observed that Resident #1 restroom needs are being met. LPA conducted interviews with residents which all stated that their restroom needs are being met. Fourth allegation, Staff is overcharging residents for services not received. Based on review of records LPA reviewed Residents #1 admission agreement along with needs and service plan and observed that Resident #1 is being charged for the services listed on residents’ admission agreement. LPA did not observe overcharge fees in resident record. LPA conducted interviews with residents, and all stated that they have not experienced any issues with services at the facility nor have they ran into any problems regarding over charge fees. Based on the evidence obtained during the course of the investigation, LPA has determined that the above allegations are Unsubstantiated. Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Administrator Cheryl Stevenson at the end of the visit.the state’s words, verbatim · CDSS document, Feb 2, 2024 · control 56-AS-20230926082949