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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200888
Report Date: 11/24/2021
Date Signed: 11/24/2021 01:25:10 PM

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:MONTECITO OAKMONT SENIOR LIVINGFACILITY NUMBER:
079200888
ADMINISTRATOR:KIT LING WONGFACILITY TYPE:
740
ADDRESS:4576 CLAYTON ROADTELEPHONE:
(925) 692-5838
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY:230CENSUS: 171DATE:
11/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Kit Ling Elaine WongTIME COMPLETED:
01:36 PM
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Licensing Program Analyst (LPA) James Sampair conducted an infection control annual inspection and explained the purpose of the visit with Executive Director Elaine Wong. All of the staff LPA observed wore facial coverings during the visit. Facility has a completed COVID-19 mitigation plan in place dated 01/12/2021. The LPA inspected the facility inside and out and observed that the practices of the LIC808 and the required COVID-19 infection control practices in general were being followed on a consistent basis throughout the facility. Those practices included them having a screening station at the front entrance that included collecting visitor information, a hand sanitizer, as well as the screening for COVID-19 symptoms and COVID-19 vaccination status. Facility has conducted staff training on infection prevention, symptoms, transmission and proper donning & doffing of PPE. Staff and residents are fully vaccinated.

The LPA observed that pathways were free of obstruction and fire hazards. Numerous activities have been scheduled for the residents on a regular basis. Sufficient food and other meal related supplies were stored in the kitchen pantries, refrigerators, and freezers.

The temperature was maintained at a comfortable level and the hot water was within the 105 to 120 degree safe range. A certified administrator is on site more than the minimum of 20 hours a week to oversee proper business operation and compliance with COVID-19 infection control practices.

No deficiencies cited during this visit. Exit interview conducted and a copy of this report was provided to the administrator.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2021
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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