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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201083
Report Date: 03/30/2022
Date Signed: 03/30/2022 01:37:29 PM


Document Has Been Signed on 03/30/2022 01:37 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:MONTECITO OAKMONT SENIOR LIVINGFACILITY NUMBER:
079201083
ADMINISTRATOR:WONG, ELAINEFACILITY TYPE:
740
ADDRESS:4756 CLAYTON ROADTELEPHONE:
(925) 692-5838
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY:230CENSUS: 177DATE:
03/30/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Elaine Wong, Executive DirectorTIME COMPLETED:
01:45 PM
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On 3/30/2022 at 09:15 Licensing Program Analysts (LPAs) L. Hall and C. Fowler conducted an unannounced pre-licensing inspection. LPAs met with Elaine Wong, Executive Director(ED) and explained the purpose of the visit. This facility is operating with residents.

LPAs toured with ED and Assistant ED, and observed all staff wearing masks. The tour included but not limited to the residents bedrooms/apartments, shared bathrooms, dining rooms, common living areas, and kitchen, There is sufficient lighting around the facility. Residents rooms/apartments are equipped with the proper furniture and lighting. The kitchen was observed cleaned and within compliance. Bathrooms were equipped with grab bars and emergency call button. Passageways and hallways are clear of obstruction. The facility was observed to be at a comfortable temperature of 73 degrees F. Fire extinguisher is in compliance. Facility has two (2) med-tech rooms. Hot water temperature is measured at 114 degrees F. in apartment 144 and 116.8 degrees F. in shared bathroom. There was 7-days of non-perishable and a 2-day supply of perishable foods available for current residents. Facility had a sufficient amount of PPE.

Staff records were reviewed showing that all have criminal record clearances and associated with the facility. Residents’ records were reviewed and found to be organized and filed properly.

No issues noted during inspection. LPAs observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura HallTELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2022
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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