Oakland Healthcare & Wellness Center

In the surveyor’s words

From the most serious findings on record at Oakland Healthcare & Wellness Center, in the surveyor’s own words.

• Immediate jeopardy, isolatedF624Apr 19, 2022

  Based on interview and record review, the facility failed to ensure one of three sampled residents (Resident 1) had a safe and orderly discharge from the facility when the facility failed to provide and document the orientation and preparations for Resident 1's discharge needs to a legally responsible party, before discharging Resident 1. The attending physician had determined Resident 1 did not have capacity to make healthcare decisions due to dementia (a chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning), and required a responsible party to make healthcare decisions. […]

• No harm, potential for more than minimal, patternF688Jan 15, 2026

  Based on observation, interview and record review, the facility failed to provide preventive treatment and services to maintain and improve range of motion (ROM is one aspect of exercise important for increasing or maintaining joint function) for three of four sampled residents (Residents 6, 75, and 26).This failure had the potential to result in further decline in Residents 6, 75, and 26's ROM. 1.A review of Resident 6's admission record (AR), undated, indicated Resident 6 was admitted on [DATE] with diagnoses that included hemiplegia (paralysis affecting one side of the body, often the face arm, leg, usually from brain or spinal cord injury), diabetes, and repeated falls. […]

• No harm, potential for more than minimal, patternF812Jan 15, 2026

  Based on observation, staff interview, and record review, the facility failed to store food in accordance with professional standards for safety when: Kitchen staff had uncovered facial hair while in the kitchen.Beyond use by date food items were stored in the kitchen refrigerator.Unlabeled, undated and expired food items were stored in the resident refrigerator. These failures had the potential for contamination of food resulting in food borne illness for the 97 residents who lived at the facility. […]

• No harm, potential for more than minimal, patternF584Jul 25, 2024

  Based on observation, interview, and record review, the facility failed to ensure maintenance services to maintain a comfortable, sanitary, and homelike environment when: 1. For Resident 39, room had a missing window covering. 2. For Resident 41, bathroom sink hot water knob was not in good working condition. 3. For Resident 58, room window could not be closed completely. 4. Multiple rooms (Rooms 5, 6, 10, 11,1 2, 16, and 19) had unclean and unpleasant bathroom environments. These failures to ensure a homelike environment had the potential to decrease residents' quality of life, comfort, and well-being. Findings: 1. A review of Resident 39's Admission Record printed on 7/24/24, indicated Resident 39 was admitted to the facility on [DATE]. […]

• No harm, potential for more than minimal, patternF645Jul 25, 2024

  Based on interview and record review, the facility failed to ensure four (Resident 32, 47, 57 and 67) of five sampled resident's Pre-Admission Screening Resident Review (PASRR) was referred to the appropriate state mental authority for evaluation and determination when; 1. Facility did not resubmit a new Level 1 PASRR screening for Residents 32, 47, 67 that remained in the facility longer than 30 days. 2. Facility did not refer Resident 57 for level 2 PASRR evaluation. These failures had the potential to prevent residents from receiving appropriate required mental health services. Findings: 1. […]