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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201084
Report Date: 02/16/2023
Date Signed: 02/16/2023 12:46:42 PM


Document Has Been Signed on 02/16/2023 12:46 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:OAKMONT OF MARINER POINTFACILITY NUMBER:
019201084
ADMINISTRATOR:VADNAIS, GERALD FFACILITY TYPE:
740
ADDRESS:2400 MARINER SQUARE DRIVETELEPHONE:
(510) 347-5959
CITY:ALAMEDASTATE: CAZIP CODE:
94502
CAPACITY:80CENSUS: 55DATE:
02/16/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Melissa Melek, Health Services DirectorTIME COMPLETED:
12:45 PM
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On 2/16/23 at 12:30 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct a case management visit due to receiving an incomplete LIC624.. LPA met with Melissa Melek, Regional Director and explained the purpose of the visit.

During the visit LPA interviewed the facility's Health Services Director and reviewed the facility's internal Incident Reprot. LPA observed on the internal Incident Report that proper notifications were made to the resident's family.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Gregory ClarkTELEPHONE: 510-285-3927
LICENSING EVALUATOR SIGNATURE:
DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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