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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201083
Report Date: 07/17/2024
Date Signed: 07/17/2024 04:51:28 PM


Document Has Been Signed on 07/17/2024 04:51 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: 178DATE:
07/17/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Agustin Samiego, Executive DirectorTIME COMPLETED:
05:00 PM
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On 7/17/2024 at 2:25pm, Licensing Program Analyst (LPA), L. Hall arrived unannounced to conduct a health and safety check combined with Contra Costa County Public Health (CCC PH) as a result of the facility having an outbreak. LPA met Agustin Samiego, Executive Director, Maria Tejon, Health Services Director, Jennifer Alexander, RN for CCC PH, and Charlene Newsome, RN for CCC PH.

During the visit CCCPH went over the checklist that gives recommendations to guide the facility during the outbreak. All toured the facility including but not limited to the pool, hot tub, dining rooms, kitchen, common areas, and checked disinfectants, cleaning products, and PPE.

LPA observed apartments with signage and PPE carts outside of the apartments of affected residents. Facility staff was wearing mask during visit. There is a minimum of 7-day non-perishables and 2-day perishables foods. There are no imminent health/safety concerns on today's date.

No deficiencies were cited today.

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: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2024
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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