<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201083
Report Date: 06/21/2023
Date Signed: 06/21/2023 11:57:10 AM


Document Has Been Signed on 06/21/2023 11:57 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 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: 187DATE:
06/21/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Elaine Wong, Executive DirectorTIME COMPLETED:
12:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 6/21/2023 at 11:20 AM, Licensing Program Analyst (LPA) P. Watson conducted a Health & Safety inspection as a result of a priority 2 complaint. LPA met with Executive Director, Elaine Wong and explained the purpose of the visit.

LPA toured facility with Elaine including but not limited to apartments, common areas, kitchen, and outdoor area. There is a minimum of 7 day of non-perishable and 2 day of perishable food supplies. Facility orders food supplies on a weekly basis. Refrigerator temperature was observed at 40 degrees Fahrenheit and Freezer temperature was observed at -15 degrees Fahrenheit. Resident's medications were kept locked. Smoke detectors and carbon monoxide detectors were in operating condition during visit. First-aid kit was complete. Fire extinguisher was observed and last serviced on 9/14/2022. LPA observed a locked gate surrounding the pool area. Indoor and outdoor passageways are free of obstruction. There are no imminent health/safety concerns on today's date.

No deficiencies cited during visit. Exit interview conducted and copy of this report provided via email.

SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 725-7926
LICENSING EVALUATOR NAME: Paris WatsonTELEPHONE: (510) 622-2625
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1