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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 092700750
Report Date: 08/11/2022
Date Signed: 08/11/2022 11:32:21 AM


Document Has Been Signed on 08/11/2022 11:32 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:OAKMONT OF EL DORADO HILLSFACILITY NUMBER:
092700750
ADMINISTRATOR:JEFF SUMABATFACILITY TYPE:
740
ADDRESS:2020 TOWN CENTER WEST WAYTELEPHONE:
(916) 467-8330
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:129CENSUS: 80DATE:
08/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Kathleen Olson, Executive DirectorTIME COMPLETED:
11:30 AM
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On August 11, 2022, at 9am, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to conduct a required 1 year Annual Inspection. LPA met with Kathleen Olson, Executive Director and informed her the reason for the visit. Prior to initiating the visit, LPA completed the required Covid-19 testing protocols, a daily self screening questionnaire and completed a facility risk assessment. LPA assured she applied hand sanitizer before entering the facility and wore N-95 mask for PPE.

Kathleen and LPA completed the Infectious Control Questionnaire with no issues or concerns.

Fire extinguisher is maintained and ready for emergency use. The facility was observed to have been annually inspected in July 2022 by Fire Code and in compliance at this time.

Per California Code of Regulations, Title 22, no deficiencies observed or cited during this visit

An exit interview was conducted and a copy of this report was given to Kathleen.

SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-LyonsTELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2022
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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